Purpose:To evaluate recurrence rates after surgical correction of ptosis in adults, with emphasis on differences between aponeurotic and non-aponeurotic etiologies, and to identify predictors of recurrence. Methods:This retrospective, single-center cohort study included a series of patients undergoing ptosis surgery at single tertiary referral Oculoplastic Unit at University of Naples Federico II (2014-2024). Data collected included demographics, ptosis subtype, surgical technique, preoperative marginal reflex distance (MRD), levator function, systemic comorbidities, and latency to treatment. The primary outcome was recurrence of ptosis. Kaplan-Meier estimates and Cox proportional hazards models were used to evaluate recurrence-free survival and predictors of recurrence. Fisher's exact test assessed associations with comorbidities. Results:A total of 122 patients (152 eyes) were included (mean age 59.7 ± 23.8 years; 54.6% male). The median follow-up was 165.1 weeks (IQR 67.0-330.6). Aponeurotic ptosis accounted for 50.7% of eyes, congenital for 30.3%, and myogenic for 18.4%. Levator repair was the most common surgical approach (78.9%). Recurrence occurred in 35 eyes (23.0%) during a median follow-up period of 165.1 weeks (IQR 67.0-330.6), Recurrence was significantly lower in aponeurotic vs non-aponeurotic ptosis (log-rank p = 0.048). In multivariable Cox analysis, non-aponeurotic ptosis was the only independent predictor of recurrence (HR 2.44, 95% CI: 1.13-5.28; p = 0.023). MRD, levator function, latency to treatment, and systemic comorbidities were not meaningfully associated with recurrence. Conclusions:Ptosis recurrence after surgery was significantly less frequent in aponeurotic ptosis group compared to other forms. Etiology, rather than preoperative assessment measurements and surgical technique, was the primary determinant of long-term outcomes. These findings highlight the importance of etiology-driven surgical counseling and follow-up planning.

OBJECTIVES:To evaluate the retinal morphofunctional changes in patients with stage 2 age-related macular degeneration (AMD) following scleral iontophoresis for lutein delivery, and to assess its safety. METHODS:In this prospective, non-randomized, single-arm pilot study, 30 stage 2 AMD patients (mean age 71.6 ± 10.88 years) received scleral iontophoresis with a liquid lutein formulation. Comprehensive ophthalmologic assessments-including best-corrected visual acuity (BCVA), macular pigment optical density (MPOD) via one-wavelength reflectometry, and microperimetry (mean sensitivity, mean defect, and fixation stability measured as BCEA)-were performed at baseline and at 6 months. Adverse events were monitored, and ocular surface health was assessed using the Ocular Surface Disease Index (OSDI). RESULTS:At 6 months, MPOD significantly increased from 0.169 ± 0.06 to 0.180 ± 0.075 density units (p = 0.0313). Mean sensitivity improved from 7.26 ± 5.13 dB to 8.18 ± 4.57 dB (p = 0.0179), and mean defect improved from -11.48 ± 4.90 dB to -10.27 ± 3.76 dB (p = 0.0207). Fixation stability, as measured by BCEA at 3 standard deviations, significantly decreased (p = 0.0107). No significant change was observed in BCVA, and OSDI scores remained stable. No adverse events were reported. CONCLUSIONS:Scleral iontophoresis of lutein is a safe and promising technique to enhance local MPOD and retinal sensitivity in intermediate AMD patients. Further studies with larger cohorts are warranted to confirm these preliminary findings.

PURPOSE:The study aimed to evaluate international practice patterns among oculofacial plastic surgeons regarding postoperative patching, given evolving evidence and uncertainties surrounding benefits and risks. METHODS:A web-based survey was distributed to members of nine oculoplastic societies worldwide. The survey included thirty-eight questions about postoperative patching practices for oculofacial procedures. Descriptive statistics, chi-squared tests and logistic regression analyses were performed to assess practice patterns and identify demographic factors associated with patching decisions. RESULTS:A total of 519 surgeons completed the survey. Patching practices varied substantially by procedure: 29.1% routinely patched after eyelid surgery, 51.1% after orbital surgery, 23.9% after lacrimal surgery, and 80.3% after skin graft surgery. Logistic regression showed that surgeons practicing outside the United States were more likely to patch for eyelid (Odds Ratio (OR) = 5.00, p < 0.001), orbital (OR = 2.94, p < 0.001), and lacrimal (OR = 1.96, p = 0.02) surgeries. Surgeons aged ≥ 40 years were less likely to patch in eyelid (OR = 0.64, p = 0.04) and lacrimal (OR = 0.51, p = 0.002) surgeries. CONCLUSIONS:Postoperative patching practices among oculofacial plastic surgeons show significant variation, influenced by geographic location, surgeon age, and procedure focus. These findings highlight the need for further research to evaluate the impact of these practices on surgical outcomes and to develop consensus guidelines that optimize patient care.

Rhino-orbital mucormycosis is a rare, life-threatening opportunistic fungal infection, typically affecting immunocompromised patients. During the COVID-19 pandemic, increased cases were mainly linked to SARS-CoV-2 infection, diabetes, and corticosteroid exposure. We report a severe case in a previously healthy 44-year-old immunocompetent man who developed acute left-sided exophthalmos, ophthalmoplegia, severe visual loss, and systemic deterioration 10 days after AZD1222 COVID-19 vaccination. Clinical and radiologic findings suggested invasive rhino-orbital fungal disease, prompting immediate liposomal amphotericin B, broad-spectrum antibiotics, urgent endoscopic sinus surgery, and repeated orbital-sinonasal debridements with amphotericin B irrigation. Histopathological examination demonstrated broad aseptate hyphae with tissue necrosis, consistent with mucormycosis, while fungal culture and ITS sequencing identified Rhizopus arrhizus as the causative species. Therapy was later adjusted to include isavuconazole and antibacterial coverage for persistent inflammation and secondary colonization. Orbital and systemic improvement occurred within the first week, with globe preservation and marked proptosis reduction at 6 months, despite persistent ophthalmoplegia and residual light perception. Isavuconazole was continued for 2 years, with no recurrence during 3 years of follow-up. Although causality with vaccination cannot be established, the temporal association and biological plausibility warrant further investigation. Early suspicion and prompt combined medical-surgical management are essential in rapidly progressive orbital cellulitis.

Background/Objectives: Macular pigment optical density (MPOD) represents a biomarker of retinal antioxidant status in intermediate age-related macular degeneration (iAMD). Strategies aimed at increasing macular carotenoid availability may contribute to disease stabilization. This study evaluated the effects of oral supplementation and transscleral iontophoresis on MPOD and retinal parameters in iAMD. Methods: This prospective, non-randomized pilot study included 60 eyes of 60 patients with intermediate AMD enrolled at the Eye Clinic of the University of Naples Federico II between July 2024 and May 2025 (ClinicalTrials.gov NCT06465342). Patients received either oral carotenoid supplementation (n = 30) or transscleral iontophoresis (n = 30). Best-corrected visual acuity (BCVA), central macular thickness (CMT), and MPOD measured by one-wavelength reflectometry ( Visucam 200; Carl Zeiss Meditec, Jena, Germany) were assessed at baseline and 6 months. Results: BCVA remained stable in both groups without significant changes (p > 0.05). MPOD significantly increased in the iontophoresis group (0.40 ± 0.11 to 0.49 ± 0.12, p < 0.001) with no statistically significant difference between them (p = 0.09). CMT showed a mild, non-significant increase in both groups (p > 0.05). No adverse events were observed. Conclusions: Both oral supplementation and transscleral iontophoresis were associated with a significant increase in MPOD while preserving visual acuity in intermediate AMD. Within the limitations of this non-randomized pilot study, transscleral iontophoresis produced MPOD changes comparable to those observed with oral supplementation. These findings are exploratory and support further investigation of localized delivery strategies in larger, randomized trials.

BackgroundMerkel cell carcinoma (MCC) of the eyelid is rare and aggressive. Diagnostic delay and inadequate excision may promote early nodal spread. We assessed the influence of surgical margins and re-excision timing on outcomes, supported by a PRISMA-guided systematic review on metastatic risk.MethodsA single-center retrospective series (2012–2024) included 9 histologically confirmed eyelid MCCs, analyzing presentation, treatment, and outcomes. Surgical strategies were classified as one-step wide local excision (1WLE, ≥5 mm), two-step wide local excision (2WLE) with early (E2WLE, ≤2 months) or late (L2WLE, 6 months) re-excision, and insufficient margin excision (IME, <2 mm without re-excision). A systematic review identified periocular MCC cases with individual-level data on margins and outcomes.ResultsPatients (median age 71.8 years, range 42–92; 89% female) all presented with solitary nodules on the upper eyelid, and were node-negative and metastasis-free at diagnosis, consistent with AJCC 8th clinical stage I–IIA.Median follow-up was 48 months (IQR 12–120). Treatments included 1WLE (n=4), 2WLE (n=3; 2 E2WLE, 1 L2WLE), and IME (n=2). Three patients (33%) developed cervical lymph node metastases within 1–3 months: one after L2WLE (fatal at 12 months) and two after IME. Both IME patients showed marked responses to Avelumab. Of the remaining six, four (67%) remained disease-free and two (33%) died of unrelated causes. Metastatic risk was significantly higher after IME versus sufficient margins (p=0.0119). In the PRISMA-guided review (76 eyelid MCC), insufficient margins correlated with adverse outcomes; in a subset without baseline metastasis (n=39), insufficient margins increased risk of recurrence/metastasis (OR 10.56; 95% CI 1.84–77.24; Fisher’s exact p=0.002).ConclusionIn eyelid MCC, adequate margins at first surgery or early re-excision are crucial to prevent early nodal spread. Our findings emphasize the prognostic value of surgical adequacy and support incorporating wide excision into initial management. Further multicenter studies are warranted to define evidence-based management pathways, improve long-term outcomes, and clarify the role of checkpoint inhibition in periocular MCC.

Background:Orbital recurrence from uveal melanomas occurs in 3-23 % of enucleated eyes and poses a management challenge. Treatment options are disfiguring, and many tumors will progress despite management with surgery and radiation. Case report:This case explores the use of pembrolizumab to an orbital recurrence of uveal melanoma. A 80-year-old man developed recurrent orbital disease 11 years after enucleation for uveal melanoma and refused exenteration. As alternate management option he received 200 mg every three weeks of pembrolizumab. The orbital recurrence was reduced in size by 60 % in dimension as measured by MRI and CT imaging. After 20 months of treatment, the patient experienced deterioration of the dementia and spontaneously discontinued the therapy. Conclusion:This case demonstrates that pembrolizumab therapy can result in tumor regression of recurrent orbital uveal melanoma and it eventually may be helpful as a neoadjuvant treatment.

Background: This study aims to analyze the clinical, radiological, and histopathological features, as well as the long-term follow-up, of patients with breast carcinoma orbital metastases. Methods: The study was a multicentric retrospective observational case series. The medical records of 32 female patients affected by breast carcinoma orbital metastases referred to three tertiary referral centers from January 2016 to December 2023 were reviewed. The demographic characteristics of the population, clinical ophthalmological presentation, histological features, orbital metastasis latency, disease-related survival (DRS), and mortality rate were analyzed. Results: The median age of the patients was 62.50 years (interquartile range (IQR): 74.50-57.50). The prevalent histotype of the orbital metastases of breast cancer was lobular carcinoma (75.00% of cases). The median orbital metastasis latency time was 39.50 months (IQR: 134.00-10.25). The median disease-related survival (DRS) during the observational period was 35 months, and the 24-month survival rate was 70.73%. The overall mortality rate in our population was 50%. Conclusions: The most frequent histotype of breast cancer orbital metastasis is lobular carcinoma. The primary tumor precedes the onset of orbital metastasis in most cases and usually presents as a mass occupying space and infiltrating the orbit. Orbital metastases are a sign of an advanced stage of the disease, which has a high mortality rate and a low DRS.

Allergic conjunctivitis is a common ocular condition characterized by discomfort, itching, and redness, which significantly impacts quality of life. Its frequent overlap with dry eye disease (DED) complicates diagnosis and management, as both conditions share inflammation and tear film dysfunction as underlying mechanisms. Effective treatments must address both the inflammatory and tear film aspects of these conditions. While traditional therapies include antihistamines and mast cell stabilizers, innovative approaches focus on agents with dual anti-inflammatory and antiallergic properties. N-acetyl-aspartyl-glutamate (NAAGA) has shown potential in alleviating symptoms of both allergic conjunctivitis and DED through mechanisms involving mast cell stabilization, inhibition of inflammatory mediators, and improvement of tear film stability. This study compares the efficacy of NAAGA and azelastine hydrochloride, an established antihistamine, in improving symptoms and clinical markers of tear film dysfunction in patients with allergic conjunctivitis. This randomized, single-blind study included 134 patients with atopy and mild to moderate tear film dysfunction. Participants received either NAAGA (49 mg/ml, four times daily) or azelastine hydrochloride (0.05

BackgroundStaphylococcal scalded skin syndrome (SSSS) is a rare but potentially life- threatening condition caused by exfoliative toxin-producing Staphylococcus aureus. Ocular involvement, although infrequently reported, may lead to vision-threatening complications if not promptly recognized.MethodsThe clinical history, findings, therapy, and outcome of two patients with SSSS exhibiting prominent ocular manifestations at disease onset were analyzed and reported. A comprehensive literature review was performed using PubMed/Medline, Embase, and Scopus incorporating search terms such as “Staphylococcal scalded skin syndrome,” “eye,” “eyelid,” “conjunctival,” “ocular manifestations,” and “ocular adnexal.”ResultsTwo pediatric patients with SSSS were identified. Case 1: a 4-year-old boy with initial blepharitis progressing to periocular scaling, conjunctival inflammation, and corneal staining, confirmed as SSSS by clinical findings and microbiology. Case 2: a 38-month-old boy presenting with bilateral eyelid edema, periocular desquamation, and perioral lesions, with negative corneal staining. Both patients were treated with systemic antistaphylococcal antibiotics (including toxin-targeting regimens) and topical ocular therapy (fusidic acid gel and hypochlorous acid spray), resulting in rapid clinical improvement and complete resolution of ocular and cutaneous lesions. The literature review identified a single reported case of a healthy adult with purulent conjunctivitis as an initial manifestation of SSSS.ConclusionAlthough rare, ocular manifestations may serve as an early indicator of SSSS. Prompt ophthalmological evaluation and combined systemic and targeted topical therapy are essential to prevent ocular sequelae. Awareness of this condition among ophthalmologists and pediatricians is critical to prevent complications and potential permanent visual impairment.

Glaucoma drainage devices (GDDs) are essential in managing complex glaucoma cases. This review focuses on the Ahmed glaucoma valve (AGV) and Baerveldt glaucoma implant (BGI), the most commonly used GDDs. We aim to evaluate complications associated with AGV and BGI, particularly post-operative hypotony. We systematically reviewed randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing AGV and BGI. The primary outcome was persistent hypotony (IOP < 5 mmHg). Secondary outcomes included hypotony maculopathy, choroidal effusion, suprachoroidal hemorrhage, vision loss, cystoid macular edema, diplopia, corneal decompensation, endophthalmitis, hyphema, further surgery for IOP control, tube interventions, exposure, and occlusion. Thirteen studies (4 RCTs, 9 NRSs) with 2,513 eyes were analyzed. AGV was associated with a lower incidence of persistent hypotony in RCTs (0.6

Background/Objectives: To evaluate the neuromodulative effects of oral intake of a fixed combination of citicoline 500 mg plus homotaurine 50 mg plus vitamin B3 54 mg plus pyrroloquinoline quinone (CIT/HOMO/B3/PPQ) or of citicoline 800 mg alone (CIT800) on retinal ganglion cell (RGC) function in glaucoma patients by pattern electroretinogram (PERG) and to investigate the effects on quality of life and visual function. Methods: Consecutive patients with primary open-angle glaucoma with controlled IOP (<18 mmHg) receiving prostaglandin analogues as monotherapy; with two reliable visual fields (Humphrey 24-2 SITA Standard) per year in the last 2 years; and an early to moderate visual field defect (MD < -12 dB) were randomized to: arm A. topical therapy + CIT/HOMO/B3/PPQ for 4 months, followed by 4 months of topical therapy + CIT800; and arm B. topical therapy + CIT800 for 4 months, then topical therapy + CIT/HOMO/B3/PPG for 4 months. Patients were examined at month 0, 4, and 8. Complete ocular examination, visual field test, PERG, and quality of life assessment (NEI-VFQ25) were performed at each visit. Results: Forty patients were selected and completed the study, and none developed or reported an adverse event. The overall mean age was 64.2 (±7.7) years, 27 were male. At the end of the intake period of both products, patients exhibited higher P50 and N95-wave amplitudes and shorter latencies compared to baseline. The crossover analysis found that PERG parameters were better when patients received the CIT/HOMO/B3/PQQ combination with a statistically significant shorter peak time of 1.24 ms (95% CI, 0.37 to 2.10; p = 0.006) in the central P50 wave, 1.32 ms (95% CI, 0.44 to 2.22; p = 0.004) in the inferior P50 wave, and 1.70 ms (95% CI, 0.09 to 3.31; p = 0.038) in the inferior N95 wave; and a statistically significant increase of 0.35 µV (95% CI, 0.10 to 0.60; p = 0.006) in the superior N95 amplitude. The crossover analysis did not reveal any significant differences between the intake of CIT800 and CIT/HOMO/B3/PQQ in terms of visual acuity or IOP. During the intake of CIT/HOMO/B3/PQQ, a significant improvement was observed in the total mean score (p = 0.004), in the general health scale (GH, p = 0.01), in the color vision scale (p = 0.006), and in the peripheral vision scale (p = 0.001). Conclusions: The present study has shown that the addition of CIT/HOMO/B3/PQQ in early glaucoma improves PERG parameters and quality of life, likely by slowing down RGC aging and enhancing mitochondrial function more significantly than citicoline 800 mg alone.

Ocular trauma remains a significant cause of vision loss, often resulting from penetrating injuries caused by foreign bodies such as glass, metal, wood, and other materials. Despite advancements in ocular surgery, retained intraorbital foreign bodies may lead to delayed complications if not promptly identified and managed. We present the case of a 59-year-old male who reported severe right eye pain and diplopia seven years following a work-related facial injury. Initially asymptomatic, a computed tomography (CT) scan later identified a 30-mm metallic foreign body lodged in the medial orbit. Surgical removal via anterior orbitotomy successfully alleviated symptoms, leading to the restoration of normal visual function and improvement of the patient's visual acuity to 10/10. This case highlights the importance of comprehensive evaluation in patients with a history of ocular trauma, even in the absence of immediate symptoms. While retained intraorbital foreign bodies may remain inert for extended periods, they can eventually cause chronic inflammation, pain, and other complications. CT imaging remains crucial for detecting metallic foreign bodies, and timely surgical intervention is essential to prevent further complications and preserve vision. Additionally, the case underscores the importance of preventive safety measures in the workplace to reduce the risk of such injuries.

Background Orbital recurrence from uveal melanomas occurs in 3 to 23% of enucleated eyes and poses a management challenge. Treatment options are disfiguring, and many tumors will progress despite management with surgery and radiation. Case Report This case explores the use of pembrolizumab to an orbital recurrence of uveal melanoma. A 80-year-old man developed recurrent orbital disease 11 years after enucleation for uveal melanoma and refused exenteration. As alternate management option he received 200 mg every three weeks of pembrolizumab. The orbital recurrence was reduced in size by 60% in dimension as measured by MRI and CT imaging. After 20 months of treatment, the patient experienced deterioration of the dementia and spontaneously discontinued the therapy. Conclusion This case demonstrates that pembrolizumab therapy can result in tumor regression of recurrent orbital uveal melanoma and it eventually may be helpful as a neoadjuvant treatment.

A 5-year-old boy presented with severe acute bilateral periorbital edema. Initial misdiagnosis was made as preseptal orbital cellulitis, and he failed to respond to conventional antibiotic therapy. Magnetic resonance imaging revealed thickening of the anterior orbital adipose tissue bilaterally, with hyperintensity on T2-weighted imaging. The biopsy unveiled lymphoma-associated hemophagocytic syndrome, specifically Epstein-Barr virus related. The patient was administered rituximab, resulting in a significant amelioration. A family history, coupled with genetic investigation, ultimately led to the diagnosis of X-linked lymphoproliferative syndrome type 1 due to a large deletion of exons 2-4 of *SH2D. Reported ocular manifestation of XLP1 includes retinal hemorrhages, disc edema, acute posterior multifocal placoid pigment epitheliopathy, and macular edema. No ocular adnexal involvement has been previously reported. This case documents a case of XLP1 syndrome affecting the ocular adnexa and emphasizes the critical need to consider underlying immunodeficiencies in patients who do not respond to conventional therapies.

Eyelid retraction, cicatricial entropion, and deformities associated with facial nerve palsy are among the eyelid malpositions most detrimental to the ocular surface, as they cause exposure, tear film instability, inflammation, and potentially significant visual impairment. These conditions present major functional and esthetic challenges, underscoring the need for a clear understanding of their mechanisms and management. A narrative review was conducted using PubMed, MEDLINE, Embase, and Google Scholar to identify English and non-English studies (with English abstracts) addressing eyelid malpositions related to thyroid eye disease, cicatricial processes, and facial nerve palsy. Screening and cross-referencing yielded 115 relevant publications. Studies were excluded if they lacked clinical relevance, did not address the target disorders, involved animals, consisted of insufficient case reports, lacked an English abstract, or were non-peer-reviewed or duplicated. Extracted information included patient demographics, clinical presentations, diagnostic methods, treatments, complications, and outcomes. In thyroid eye disease, eyelid retraction results from adrenergic overstimulation, increased Müller muscle tone, and fibrosis involving the levator-superior rectus complex. Temporary improvement may be achieved with botulinum toxin, corticosteroids, or soft-tissue fillers, whereas sustained correction requires individualized surgical approaches. Cicatricial entropion arises from posterior lamellar contraction caused by inflammatory or iatrogenic injury and is best treated with lamellar repositioning or grafting procedures. In facial nerve palsy, incomplete blinking, punctal malposition, and lacrimal pump dysfunction contribute to tearing and ocular surface instability; management prioritizes corneal protection, eyelid rebalancing, and adjunctive measures such as botulinum toxin or physiotherapy. Across all conditions, tailored, multidisciplinary care is essential to maintain ocular surface integrity, restore eyelid function, and preserve quality of life.

Keratoconus is a bilateral and asymmetric degenerative eye disease that causes corneal thinning and bowing, leading to irregular astigmatism and vision loss. Although environmental and genetic factors contribute to the disease’s development, the exact cause and underlying pathological mechanism remain unknown. In this review, we comprehensively explore the latest pathophysiological mechanisms of keratoconus, focusing on oxidative damage and inflammation. Senescence emerges as a key driver of keratoconus pathogenesis. Understanding these common elements enhances our understanding of the disease and paves the way for innovative therapeutic approaches to keratoconus.

Background: Naso-ethmoidal schwannoma is a rare slow-growing tumor arising from the Schwann cells of the sinonasal tract. This study discusses the evolution of surgical approaches to naso-ethmoidal schwannomas with respect to tumor growth and recent advances in minimally invasive techniques. Materials and Methods: A comprehensive literature review on Embase online electronic database on benign naso-ethmoidal schwannoma was performed. Demographic, clinical, neuroradiological, pathological, and surgical factors were analyzed and discussed. Results: Twenty-five cases met the inclusion criteria. No predilection for gender was evident. The mean age at diagnosis was 40.2 years old. Nasal obstruction was the most common presenting symptom (64%), followed by headache (60%), hypo-anosmia (24%), and visual impairment (24%). Skull base and orbital involvement were registered in 64% and 16% of cases, respectively. Surgery is the unique curative treatment, with the endoscopic endonasal approach which plays the leading role (44%). Gross total resection was possible in all cases and was associated with no recurrence. The perioperative complication rate was 32% and mainly consisted of cerebrospinal fluid leakage. The mean time for treatment was 21 months. All patients were alive at last follow up. Conclusion: Surgery is the only curative treatment for naso-ethmoidal schwannomas, with the main goal to relief clinical manifestations. The endoscopic endonasal route represents the master approach for lesions confined to the midline. Transcranial and transorbital approaches play a complementary role when large intracranial extension and orbital involvement occur, respectively.