Hoagland Sign-A Common Diagnosis Preceded by an Uncommon Sign.

Disproportionality Analysis of Nemolizumab in Patients with Atopic Dermatitis: A Real-World Pharmacovigilance Study.

Infectious keratitis is a major cause of corneal blindness, with bacterial keratitis particularly prevalent in tropical, agriculture-dominant regions such as Southern Vietnam. To identify the demographic characteristics, risk factors, clinical features, and antibiotic susceptibility patterns of bacteria isolated from patients with corneal ulceration. A case series was conducted involving patients who presented to the Cornea Department of Ho Chi Minh City Eye Hospital between November 2020 and October 2021. A total of ninety-nine cases of bacterial keratitis were documented. The mean age of the patients was 48.2 ± 15.3years. Most participants were male, and the majority were cultivators (30.3%). Meibomian gland dysfunction was the most frequent predisposing factor (57.6%), followed by ocular trauma (52.5%) and diabetes mellitus (16.2%). The mean duration from symptom onset to presentation was 4.1 ± 3.1days; however, patients with Pseudomonas aeruginosa keratitis presented significantly earlier (2.8 ± 1.6days) than those with other bacterial infections. The most commonly isolated organisms were coagulase-negative Staphylococcus (57.6%) and Pseudomonas aeruginosa (21.2%). Staphylococcus spp. keratitis was significantly associated with peripheral infiltration, shallow stromal involvement, and absence of hypopyon. In contrast, Pseudomonas aeruginosa keratitis was strongly associated with eyelid edema, conjunctival edema, central infiltration, deep stromal involvement, stromal melting, ring infiltrate, retrocorneal plaque, hypopyon > 1mm, and fibrin formation in the anterior chamber. The majority of coagulase-negative Staphylococcus isolates were susceptible to vancomycin (90-100%). Pseudomonas aeruginosa isolates were highly susceptible to tobramycin (100%) and levofloxacin (95.0%), whereas none were susceptible to moxifloxacin. The proportions of multidrug-resistant isolates among coagulase-negative Staphylococcus and Pseudomonas aeruginosa were 68.4% and 85.7%, respectively. Multidrug-resistant strains among coagulase-negative Staphylococcus and Pseudomonas aeruginosa were notably prevalent. Our study provides valuable insights into the clinical and microbiological patterns of bacterial keratitis, which guide antibiotic selection and management.

Carotid-cavernous fistulas (CCFs) are rare vascular anomalies involving abnormal communication between the carotid arterial system and the cavernous sinus. Direct CCFs, often post-traumatic, occur mainly in young males after craniofacial trauma. We report the case of a 28-year-old male presenting with progressive pulsatile exophthalmos and eyelid edema following a road traffic accident. Non-contrast CT and CT angiography identified multiple craniofacial fractures, early enhancement of the superior ophthalmic vein, and asymmetrical bulging of the cavernous sinus, confirming a direct post-traumatic CCF. This case emphasizes the essential role of CT imaging, as a non-invasive tool, in early detection and management planning of post-traumatic CCFs, particularly in settings where immediate angiography may not be available.

To provide an up-to-date systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating the postoperative outcomes of two lateral osteotomy techniques (external vs. internal) in patients undergoing rhinoplasty. We conducted a comprehensive search in PubMed, Scopus, Web of Science, Embase, and the CENTRAL from their inception until January 2025. Eligible RCTs were assessed for risk of bias using Cochrane's risk of bias tool. The specific outcomes included clinically relevant measures, such as eyelid edema, ecchymosis, and step-off deformity. Standardised mean differences (SMD) and risk ratios (RR) with 95% confidence intervals (CIs) were used to combine the data. STATA software was used for statistical analysis. A total of 13 RCTs involving 1008 patients were included. Five RCTs demonstrated a low risk of bias, six had some concerns, and two exhibited a high risk of bias. The pooled analysis showed no significant difference in eyelid edema between the external and internal osteotomy groups at 2 days (SMD = -0.13, 95% CI [-0.49, 0.22]), 3 days (SMD = -0.14, 95% CI [-0.77, 0.48]), and 7 days (SMD = -0.08, 95% CI [-0.27, 0.12]). Similarly, no significant difference was observed in ecchymosis between the two groups at 2 days (SMD = -0.12, 95% CI [-0.51, 0.27]), 3 days (SMD = -0.21, 95% CI [-1.11, 0.70]), and 7 days (SMD = -0.10, 95% CI [-0.33, 0.12]). The mean score of step-off deformity was significantly higher in the external osteotomy group compared to the internal osteotomy group (SMD = 0.54, 95% CI [0.19, 0.89]), whereas the rate of step-off deformity did not differ significantly between the groups (RR = 0.79, 95% CI [0.43, 1.44]). This updated systematic review and meta-analysis of 13 RCTs involving 1008 patients demonstrated comparable outcomes between external and internal lateral osteotomy in terms of postoperative eyelid edema, ecchymosis, and step-off deformity in patients undergoing rhinoplasty. PROSPERO: CRD420251003922.

Purpose: the aim of this research is to evaluate the usefulness of a photocoagulator laser beam as a hot blade to remove the chalazion on an outpatient basis while the patient is seated with his head positioned in front of a slit-lamp microscope. Materials and methods: this prospective, observational study involved 3675 chalazia in 2840 patients, including 1643 males and 1197 females, with a mean age of 36.4 years (range 11-90 years). 462 patients had more than one chalazion. The patient’s head is positioned in front of the slit-lamp biomicroscope, his eyelid is fixed with a chalazion clamp and then a small vertical incision of the palpebral conjunctiva (internal chalazion) and tarsus (external chalazion) is performed with a Neodymium-doped Yttrium Aluminium Garnet Laser (532 nm laser photocoagulator). The surgical approach is always transconjunctival. The chalazion contents are curetted and removed. Patients were followed up at 15 and 30 days. Results: fifteen days after surgery, 3630 chalazia (98.8%) were completely removed with excellent functional and aesthetic results. In 45 cases (1.2%), redness and swelling of the eyelid persisted due to the presence of granuloma residues. After fifteen days of local treatment with antibiotic-steroid ointment, 20 cases (0.53%) healed, while in the other 25 cases (0.67%) the granuloma residues were removed using the same surgical technique. After thirty days, the chalazion was not palpable in all cases. Conclusion: this procedure proved to be simple, quick, effective, safe and well tolerated by patients. Furthermore, the use of the photocoagulator laser beam reduced the risk of bleeding, making the operating field dry and clearly visible thanks to the use of the biomicroscope, promoting rapid resolution of the eyelid oedema. The technique is contraindicated in uncooperative patients who require anaesthetic assistance.

BACKGROUND: Retrobulbar block is known to cause varying degrees of upper eyelid edema associated with moderate exophthalmos, which may adversely affect surgical conditions. It has been hypothesized that anatomical differences in the ocular adnexa between patients with Asian and European eyelid anatomy may determine the severity of edema following retrobulbar block. AIM: This study aimed to evaluate the effectiveness of retrobulbar block and the surgeon’s comfort during surgery in patients with Asian and European eyelid anatomy. METHODS: A prospective controlled study was conducted involving 80 patients aged 51–75 years who underwent retrobulbar block for anesthesia during vitreoretinal surgery. Group 1 (n = 40) included patients with European eyelid anatomy, and group 2 (n = 40) with Asian eyelid anatomy. Changes in intraocular pressure and upper eyelid thickness were assessed at different stages of the block, along with preparation time for surgery, analgesia level, akinesia, and surgeon’s comfort. RESULTS: In group 1, the upper eyelid thickness increased by 0.9 ± 0.1 mm, whereas in group 2 it increased by 2.8 ± 0.4 mm (p = 0.000), due to postseptal infiltration of the upper eyelid tissue with local anesthetic. The mean akinesia score was 1.0 ± 0.2 in group 1 and 1.4 ± 0.6 in group 2 (p = 0.021), with higher scores indicating reduced akinesia effectiveness. In group 1, intraocular pressure increased to 17.6 ± 1.9 mm Hg after the retrobulbar block and was 15.9 ± 1.9 mm Hg after compression, which corresponded to the baseline values before the block. In group 2, maximal increase in intraocular pressure was recorded after the retrobulbar block—24.9 ± 6.3 mm Hg (p = 0.0000)—and after compression—21.5 ± 5.4 mm Hg (p = 0.0000), which exceeded the baseline values (16.2 ± 1.3 mm Hg). The presence of ocular hypertension resulted in additional preoperative preparation time aimed at reducing intraocular pressure: in 5% of patients in group 1 and 28.75% of patients in group 2. Pain assessment showed residual pain in group 2 (2.6 ± 1.3 on the numeric rating scale), 1.5 times higher than in group 1 (1.6 ± 1.5, p = 0.0001), requiring additional intraoperative analgesia. Surgeon’s comfort in group 2 was reduced due to decreased palpebral fissure width from 21.4 ± 1.1 mm to 14.8 ± 1.9 mm after the retrobulbar block, associated with anesthetic infiltration of the upper eyelid. CONCLUSION: Retrobulbar block in patients with Asian eyelid anatomy was associated with a significant increase in eyelid thickness and intraocular pressure, prolonged surgical preparation time, and the need for additional intravenous analgesia, resulting in reduced surgeon comfort during ophthalmic procedures.

Linezolid is an antibiotic of the oxazolidinone class which is highly effective in the treatment of serious Gram-positive infections. It is usually well tolerated, but rare adverse reactions like angioedema have been reported. This case report investigates the occurrence of eyelid angioedema induced by linezolid. The patient, a man in his early 70s with sepsis and cellulitis caused by Streptococcus pyogenes, developed bilateral eyelid angioedema after receiving a second dose of linezolid. The drug was discontinued and supportive treatment with methylprednisolone and azelastine eye drops resolved the symptoms within 72 hours. The temporal link between drug administration and eyelid oedema supports linezolid as the likely trigger, confirmed by the Karch-Lasagna and Naranjo algorithms.

BackgroundThyrotrophin receptor antibody (TRAb)-negative thyroid eye disease (TED) constitutes a clinically significant subset of TED, yet its features remain inadequately characterized. This study characterizes the clinical features of TRAb-negative TED patients.MethodsIn this cross-sectional study, conducted at a Chinese tertiary hospital, 86 TRAb-negative TED patients underwent comprehensive ocular examinations and thyroid function tests. Clinical characteristics were systematically analyzed.ResultsOf the 86 patients (mean age 45.24 ± 10.78 years; 53.5% female), 86.0% (n=74) exhibited bilateral ocular involvement. The primary manifestations included proptosis, eyelid edema, and eyelid retraction. The TPOAb (-)/TGAb (+) subgroup demonstrated significantly higher frequencies of eyelid erythema and lagophthalmos, along with severe NOSPECS grading, reduced visual acuity, elevated orbital pressure, and marked soft tissue involvement (all p<0.05). TPOAb-positive patients had significantly greater proptosis (p<0.05), while TGAb-positive patients showed an increased incidence of eyelid erythema (p<0.05). TGAb was identified as an independent risk factor for eyelid erythema (p<0.01).ROC analysis for TGAb predicting eyelid erythema yielded an AUC of 0.851 (sensitivity 0.778, specificity 0.831) at 3.980 IU/mL.ConclusionTRAb-negative TED displays distinct clinical features. TPOAb and TGAb levels are associated with specific manifestations, highlighting their potential value in the assessment and management of TRAb-negative TED.

BackgroundEyelid edema is a frequent and distressing early complication of upper blepharoplasty, yet optimal postoperative management remains unsettled. Conventional cryotherapy (e.g., ice packs, cooling masks) provides unstable temperatures and can cause adverse effects. Systemic anti-inflammatory drugs are not suitable for all patients. Hilotherapy provides constant, precisely controlled cooling and has reduced swelling in maxillofacial surgery. Its value in eyelid procedures is unknown. This study used three-dimensional (3D) stereophotography to objectively quantify periocular changes and evaluate whether Hilotherapy reduces early postoperative eyelid edema after upper blepharoplasty.MethodsTwenty-three patients with symmetrical bilateral dermatochalasis (46 eyes) undergoing upper eyelid blepharoplasty under local anesthesia were enrolled. Surgery was performed simultaneously on both eyelids by two experienced surgeons using an identical technique. Hilotherapy was applied to one randomly assigned eye, with the contralateral eye serving as an untreated control. Eyelid edema was assessed using 3D stereophotography at four time points: immediately after treatment (T0), 24 hours (T1), 2 weeks (T2), and 3 months (T3) postoperatively.ResultsOf the 23 patients (9 males, 14 females; mean age 65 years), 16 (69.6%) showed reduced swelling with Hilotherapy at T0, 15 (65.2%) at T1, and 13 (56.5%) at T2. In the treatment group, males had significantly more eyelid swelling than females at T0 (1.216±0.655 vs. 0.665±0.667 cm2, P=0.023), but this difference was not significant at T1 (1.343±0.579 vs. 1.019±0.784 cm2, P=0.166) or T2 (0.474±0.573 vs. 0.354±0.342 cm2, P=0.801). Compared to controls, the swelling was significantly lower in the treated eyelids at T0 (0.880±0.715 vs. 1.129±0.915 cm2, P=0.026) and T1 (1.146±0.728 vs. 1.399±1.059 cm2, P=0.042), indicating that Hilotherapy effectively reduces early postoperative eyelid edema.ConclusionsHilotherapy is a well-tolerated and effective method for reducing postoperative eyelid edema in the early days following upper eyelid blepharoplasty. It may enhance postoperative care not only in blepharoplasty but potentially in eyelid surgery overall.

INTRODUCTION Cranial autonomic symptoms (CAS) are increasingly identified in migraine patients, making diagnosis more challenging due to similarities with Trigeminal Autonomic Cephalagias (TACs). This study is conducted to determine the prevalence of CAS in Nepalese migraine cohort and highlight diagnostic in improving diagnostic accuracy and guiding individualized treatment in resource limited setting. MATERIAL AND METHODS This cross-sectional study involved 150 migraine patients at a Medical College Headache clinic, Department of Psychiatry in Nepal. Psychiatrists applied ICHD-3 beta criteria for diagnosis and assessed the presence of CAS. Data were collected using a pretested structured interview questionnaire and analyzed with SPSS version 16, using both descriptive and inferential statistics. Ethical approval was obtained from the Institutional review Committee (IRC-DMCRI/047/2022) of Devdaha Medical College, and written informed consent was secured. Strict confidentiality of participants’ information was maintained throughout the study. RESULTS At least one CAS was reported by 73.3% of patients. The most common symptoms were eyelid edema (54.5%), conjunctival injection (49.1%), lacrimation (47.3%), and aural fullness (45.5%). CAS occurred more often in males (86.7% vs. 70% in females) and was most frequent in the 20-30 year of age group (85.0%). CONCLUSION CAS is common in migraine and may mimic TACs or other secondary headaches. Routine screening can improve diagnostic accuracy and guide individualized treatment plans.

Management of orbital complications of acute rhinosinusitis: A 13-year experience.

ABSTRACTPurpose:To investigate the demographic profile, risk factors, clinical manifestations, and treatment outcomes of patients with orbital mucormycosis in the post-COVID-19 context.Methodology:Retrospective analysis was conducted on the medical records of patients diagnosed with biopsy proven orbital mucormycosis following a confirmed or suspected history of COVID-19 infection. Data regarding demographic features, personal profile, COVID-19 status, ocular manifestations, radiological findings, treatment modalities, and outcomes were collected and analyzed.Results:Among the 14 patients in the study, the duration between COVID-19 onset and mucormycosis onset was 14.1 days on average. Comorbidities, particularly diabetes mellitus and hypertension, were prevalent among both COVID-19-positive and COVID-19-negative patients. Ocular manifestations at presentation included pain (80%), lid edema (100%), restricted extraocular movements (86.67%), and proptosis (53.33%). Ethmoid sinus involvement was most common (33.34%), along with pterygopalatine and inferior orbital fissure involvement (66.67%). Sinus debridement was the primary treatment modality (93.34%), with transcutaneous retrobulbar amphotericin B (TRAM-B) used in 46.67% of cases. Among 14 patients, 80% achieved globe salvage, while 40% had improved visual acuity and motility. Significant prognostic factors included intracranial extension and ICU admission.Conclusion:Aggressive surgical and antifungal management, supported by a multidisciplinary approach, improves outcomes in this life-threatening condition.

Preseptal cellulitis, the most common periorbital cellulitis manifestation, is more common in children. The aim of this cross-sectional study was to analyze the diagnosis and treatment of preseptal cellulitis infections in patients admitted to Children's Medical Center, an Ira-nian referral hospital, between 2015 and 2019. The demographic characteristics of patients, symptoms at admission, affected eye (unilat-eral/bilateral and right/left), the duration of symptoms and treatment, imaging findings, and the mi-crobial culture were recorded from patient history and medical files. During 5 years, 136 children with preseptal cellulitis, of whom 71 (52.2%) were boys and 65 (47.8%) were girls. The age range of the patients was between 9 days and 15 years, with a mean age of 41.9±39.3 months. All of the children had eyelid swelling and edema upon their initial visit. The most common accompanying symptoms in patients after edema and swelling of the eyelids were fever (41.2%), followed by eye discharge in 30.1%, and tenderness in 19.9% of patients. Ocular in-volvement was 51.5% in the right eye, 44.9% in the left eye, and 3.7% in both eyes. A CT scan was performed in 58 cases (42.6%), showing preseptal cellulitis in 29 patients (21.3%), followed by eth-moid sinusitis in 14 cases (10.3%). The most commonly used antibiotics, either alone or in combina-tion, were clindamycin (72.8%, n=99), ceftriaxone (54.4%, n=74), vancomycin (27.2%, n=37), met-ronidazole (23.5%, n=32), and cefotaxime (17.6%, n=24). Preseptal cellulitis in children presents with a spectrum of symptoms and is frequently associated with risk factors such as sinusitis, odontogenic infections, insect bites, or periocular trauma. Imaging, particularly CT, is essential for evaluating disease severity and identifying compli-cations. One limitation of this study is the occurrence of negative culture results, which could be due to factors such as sample collection, transportation, or possible issues with the culture techniques. According to this study, children with preseptal cellulitis might exhibit a variety of symptoms. The most common risk factors for preseptal cellulitis infection are sinusitis, odontogenic infections, animal or insect bites, and periocular trauma. Patients usually received clindamycin, ceftri-axone, and combination antibiotics.

Introduction: Chronic kidney disease affects every organ system including the eye. Aims: To study the prevalence of anterior and posterior segment ocular findings in patients with chronic kidney disease. Methods: This was a hospital based cross-sectional study conducted among 86 patients of chronic kidney disease of all ages and either gender from June 2024 to November 2024. Standard proforma was used to collect socio-demographic and clinical variables of the patients. Detailed ocular examination including fundus evaluation was done and diabetic retinopathy and hypertensive retinopathy was graded according to the Early Treatment of Diabetic Retinopathy Study (ETDRS) classification and Keith-Wegener-Barker classification respectively. Results: The mean age of the study sample was 60.73 (±14.80) years with male preponderance (62.79%). The commonest cause of chronic kidney disease was both (diabetes and hypertension) (45.35%) followed by hypertension (40.70%). The most prevalent anterior segment ocular finding was pingecula (60.47%) followed by eyelid edema (36.05%), cataract (31.40%) and conjunctival pallor (27.91%). Retinopathy (72.09%) was the most prevalent posterior segment ocular finding. Among retinopathy, the prevalence of hypertensive retinopathy, diabetic retinopathy and both retinopathy (hypertensive and diabetic retinopathy) was 51.61%, 30.64% and 17.74% respectively. The prevalence of vitreous haemorrhage, tractional retinal detachment and maculopathy was 1.16%, 2.33% and 9.67% respectively. Conclusion: There is high prevalence of ocular findings in the chronic kidney disease. Regular ocular examination is mandatory for early detection and treatment to prevent ocular morbidity and blindness in chronic kidney disease.

Botulinum toxin is a noninvasive cosmetic procedure that relaxes facial expression muscles to mitigate the development of dynamic wrinkles. It inhibits nerve signals, temporarily paralyzes muscle activity, and reduces muscle contractions, thereby smoothing the skin and minimizing wrinkles. Botox injection for wrinkle reduction has become a widely used antiaging treatment due to its rapid effects, noninvasive nature, and short recovery time. Common adverse effects include local swelling, bruising, and ptosis, while eyelid oedema occurs less frequently. This study presents a case of allergic conjunctivitis and eyelid oedema occurring several days following botulinum toxin injection for wrinkle reduction.

Background: Graves’ orbitopathy (GO) is a common autoimmune disorder affecting the eye muscles and orbital tissues, often leading to eyelid edema. The potential role of liver enzymes in this condition remains unclear.Methods: We conducted a retrospective cross-sectional study on 303 GO patients from Wuhan Union Hospital between 2015 and 2025. Participants were grouped according to the presence of eyelid edema. Univariable and multivariable logistic regression models were applied to evaluate the associations between alanine transaminase (ALT), aspartate aminotransferase (AST), and eyelid edema, with adjustments for sex, age, and lymphocytes.Results: Our analysis showed that lower ALT and AST levels were significantly associated with an increased likelihood of eyelid edema in the fully adjusted models (ALT per 10 U: OR = 0.813, 95% CI = 0.678-0.975; AST: OR = 0.681, 95% CI = 0.489-0.947). A linear dose-response relationship was observed: for each 10-unit decrease in ALT or AST, the observed prevalence of eyelid edema increased by 18.7%-31.9%.Conclusion: This study demonstrated an association between liver enzymes (AST and ALT) and eyelid edema in GO patients. The findings suggest a potential link between liver function and the pathogenesis of GO-related edema. Further prospective studies are required to clarify the causal relationship, explore the underlying mechanisms, and assess the clinical utility of liver enzymes as biomarkers for GO severity or progression.

BACKGROUND: Allergic conjunctivitis involves an inflammatory reaction that destabilizes the tear film and promotes dry eye syndrome. Topical antihistamines may contribute to ocular surface dryness. Aim: The study aimed to compare the tolerability and clinical effect of topical dual-action anti-allergic agents, including 0.05% epinastine, 0.2% olopatadine, and 0.1% olopatadine, in patients with seasonal allergic conjunctivitis in a standard clinical practice. METHODS: The study included 33 patients (66 eyes) with seasonal allergic conjunctivitis. The patients were equally divided into three groups to receive 0.05% epinastine (n=11), 0.2% olopatadine (n=11), and 0.1% olopatadine (n=11). Symptom severity was assessed using the itching scale, Efron grading scale, eyelid edema scale, and Munk scale for epiphora grading. Dry eye symptoms were assessed using the Schirmer and Norn tests. The therapy duration was 14±2 days. RESULTS: By the study end, mean tear film breakup time in the 0.05% epinastine group almost did not change compared to baseline and was 9.4±1.41 s vs. 9.6±1.39 s (OD) and 9.3±1.34 s vs. 9.5±1.43 s (OS). However, in the 0.1% and 0.2% olopatadine groups, it decreased and was 13.9±3.21 s vs. 11.6±2.88 s (OD) (p=0.043), 14.1±3.25 s vs. 11.6±3.06 s (OS) (p=0.019) and 10.63±1.51 s vs. 8.5±1.41 s (OD) (p=0.003), 10.75±1.28 s vs. 8.63±1.3 s (OS) (p=0.003), respectively. The lowest number of adverse reactions was observed in the 0.05% epinastine group. CONCLUSIONS: 0.05% epinastine caused less dry eye symptoms and was well tolerated in patients with seasonal allergic conjunctivitis.

Myasthenia gravis (MG) is an autoimmune disorder characterized by weakness and fatigability of skeletal muscle. Juvenile myasthenia gravis (JMG) is MG in patients under the age of 18. The incidence is estimated to be 5.9 - 8.7 per million person-years. In ocular JMG, a subtype of JMG, symptoms are isolated to eye muscles. This case report presents the diagnostic journey of a 3-year-old non-Asian female from Virginia, USA, who initially exhibited symptoms consistent with ocular JMG. The patient’s early symptoms, including eyelid drooping and watery eyes, were initially misattributed to eye irritation and upper respiratory infection symptoms. However, suspicion for JMG emerged as her condition progressed to include bilateral ptosis, facial weakness, and other bulbar symptoms. The diagnostic process involved interdisciplinary collaboration and continued revisal of the differential diagnoses as symptoms evolved. The diagnosis was ultimately confirmed with a positive JMG panel, including elevated acetylcholine receptor (AChR) binding and modulating antibodies. This case highlights the importance of considering JMG in the differential diagnosis of ocular and bulbar symptoms, and the challenges associated with diagnosis of rare diseases. Tailored management strategies, including acetylcholinesterase inhibitors and potential immunosuppressive agents, should be considered based on individual patient needs. Keywords : Myasthenia Gravis, Neuromuscular Disorders, Ptosis, Autoimmune, Facial Weakness.

Prone position has been reported to improve prognosis and reduce mortality in COVID-19 patients, but poor patient tolerance and complications remain an issue. This study aimed to compare the modified vs. conventional prone position on pressure injuries in COVID-19 patients in adult intensive care units (ICU). This retrospective comparative study enrolled COVID-19-positive patients who were admitted to the emergency adult ICU of a tertiary general hospital between December 2022 and January 2023. All data were extracted from patient charts. The primary outcome was pressure injury. During the study period, pressure injuries were evaluated using the staging system of the International Clinical Practice Guideline for the prevention and treatment of pressure injuries in 2019. A total of 39 COVID-19-positive patients (16 females) were included, and 19 patients received the modified prone position. Compared to those with the conventional prone position, patients with the modified prone position had significantly lower occurrence of pressure injury (3 (25.0%) vs. 9 (75.0%), p = 0.044), eyelid oedema (2 (10.5%) vs. 9 (45.0%), p = 0.031) and facial oedema (5 (26.3%) vs. 13 (65%), p = 0.024) and significantly higher daily continuous prone position time (9.16 ± 3.01 vs. 6.50 ± 2.14, p = 0.003). The occurrence site and stage of pressure injury, transcutaneous blood oxygen saturation, airway adverse events and brachial plexus injury were comparable between the groups (all p > 0.05). Compared to the conventional prone position, the modified prone position may significantly reduce the occurrence of pressure injuries and improve patient tolerance in COVID-19 patients in the adult ICU. These findings provide guidance for critical care nurses to implement prone positioning interventions.