BACKGROUND:Interstitial keratitis is a classic manifestation of late congenital syphilis, typically presenting in childhood or adolescence. Adult-onset presentation is rare and poses a diagnostic and therapeutic challenge, particularly in patients without a known history of congenital infection. CASE REPORT:We report a 28-year-old man with an 11-year history of progressive bilateral ocular redness, tearing, and visual decline who was found to have bilateral interstitial keratitis with positive treponemal and negative nontreponemal serologies, consistent with late congenital syphilis. Despite treatment with intravenous penicillin G and adjunctive topical corticosteroids, the clinical course was complicated by refractory inflammation, progressive stromal scarring, corneal thinning, and perforation requiring tectonic patch grafting. Recurrent inflammatory flares persisted despite sustained steroid therapy and negative nontreponemal serologies. Visual rehabilitation required prolonged multidisciplinary management with rigid corneal and scleral contact lenses. CONCLUSION:This case highlights the diagnostic and therapeutic complexity of adult-onset presumed congenital syphilitic interstitial keratitis. In cases where a definitive diagnosis cannot be confirmed, close collaboration among infectious disease, ophthalmology, and optometry is needed to navigate treatment decisions, manage refractory inflammation, and guide visual rehabilitation. This case demonstrates that specialty contact lens fitting and sustained interdisciplinary care are essential in restoring functional vision.
OBJECTIVES:This study aimed to evaluate the short-term effect of a prostaglandin analog-based eyelash serum on the ocular surface. METHODS:A prospective interventional study was conducted on 19 healthy women. Participants applied an eyelash serum containing dechloro dihydroxy difluoro ethylcloprostenolamide once daily to the upper eyelid margin for 6 weeks. Tear film parameters, meibomian glands analysis, and ocular surface inflammation and damage were assessed at baseline and posttreatment using the S390L slit lamp (Firefly WDR, MediWorks, Shanghai, China). RESULTS:A significant reduction in tear film stability was observed, with decreases of 3.92±7.45 sec in first noninvasive break-up time ( P =0.003) and 3.97±6.25 sec in average noninvasive break-up time ( P <0.001). Tear volume was reduced, as shown by decreases of 0.01±0.04 mm in tear meniscus height ( P =0.049) and 0.27±0.66 mm 2 in tear meniscus area ( P =0.019). Ocular hyperemia increased, with temporal ciliary hyperemia rising by 1.68±3.45% ( P =0.006) and temporal conjunctival hyperemia by 2.41±4.14% ( P =0.001). No statistically significant changes were observed in meibomian gland morphology or ocular surface staining. CONCLUSIONS:Daily application of the prostaglandin analog-based eyelash serum induced tear film instability, reduced tear volume, and increased ocular hyperemia. These findings suggest that even short-term use may disrupt ocular surface homeostasis and cause mild inflammation. Further studies with longer follow-up are needed to assess its safety profile on the ocular surface.
ABSTRACT:Zanubrutinib, a second-generation Bruton tyrosine kinase inhibitor used in B-cell malignancies, has a favorable systemic safety profile, whereas its ocular surface effects remain insufficiently defined. We report a 73-year-old woman receiving zanubrutinib for mantle cell lymphoma who presented with acute pain and decreased vision in the right eye. Slitlamp examination revealed a corneal epithelial defect with an associated stromal infiltrate in the right eye and bilateral epithelial surface abnormalities. The patient reported three months of bilateral ocular irritation and conjunctival hyperemia before this acute presentation. Corneal cultures grew Moraxella nonliquefaciens . Topical antimicrobial therapy resulted in resolution of the infiltrate. However, ongoing bilateral epithelial instability with microcystic changes required adjunctive topical corticosteroids, leading to substantial clinical improvement. The prolonged bilateral prodrome preceding the acute infectious episode, together with the absence of prior ocular disease, raises concern for zanubrutinib-associated ocular surface dysfunction predisposing to secondary infection. To the best of our knowledge, this is the first report suggesting an association between zanubrutinib therapy and corneal surface disease. This case raises a potential ocular side effect of zanubrutinib, emphasizing the need for further investigation. As immunotherapy use expands, ophthalmologists should remain vigilant for emerging ocular toxicities and collaborate with oncology specialists for optimal patient care.
OBJECTIVES:To review the role of Demodex infestation in blepharitis and summarize available evidence on the efficacy and safety of topical and oral ivermectin. METHODS:This narrative review was conducted through collaboration between expert ophthalmologists and infectious diseases specialists with clinical experience in the use of ivermectin. A literature search was performed in PubMed and Embase from inception to November 2025. RESULTS:Evidence from clinical trials, observational studies, and case series was reviewed and synthesized. Ivermectin, administered orally or topically, has been investigated as a potential treatment option for Demodex -associated blepharitis, either as monotherapy or in combination with other therapies. Across different treatment protocols and patient populations, ivermectin use was generally associated with reductions in Demodex mite density, improvement in cylindrical dandruff, ocular surface parameters, and patient-reported symptoms. Reported adverse events were infrequent and predominantly mild. CONCLUSIONS:Current evidence suggests that ivermectin may represent an effective and overall safe therapeutic option for Demodex -associated blepharitis. Further studies are needed to establish standardized treatment regimens and to assess long-term outcomes.
