Obstructive Sleep Apnea Syndrome (OSAS) is a common sleep disorder involving recurrent upper airway obstruction during sleep, leading to intermittent hypoxia, oxidative stress, and systemic inflammation. Although OSAS has been linked to several ocular disorders, its specific impact on ocular surface health, particularly in relation to dry eye disease (DED) and corneal sensitivity, is not fully understood. This study aimed to assess how OSAS severity influences dry eye parameters and corneal sensitivity, and to explore associations with systemic and demographic factors. In this cross-sectional study, 174 patients diagnosed with OSAS via overnight polysomnography were divided into normal–mild OSAS and moderate–severe OSAS groups. Ocular surface assessments included non-invasive tear break-up time (NIBUT), Schirmer II test (ST), Ocular Surface Disease Index (OSDI), and corneal sensitivity measured in five corneal regions using a Cochet–Bonnet esthesiometer. Statistical analyses involved group comparisons, correlation assessments, and multivariable linear regression to identify predictors of dry eye parameters. Moderate–severe OSAS (AHI ≥ 15; n = 85) patients were older, had higher BMI, and lower minimum oxygen saturation (p < 0.001). No significant differences were observed between groups in NIBUT, ST, or regional corneal sensitivity. Interestingly, OSDI scores were lower in the moderate–severe group, nearing statistical significance (p = 0.055). ST was positively correlated with corneal sensitivity (r = 0.22–0.26), whereas OSDI was negatively correlated (r = − 0.14– − 0.18). Regression analyses identified age and smoking as significant predictors of NIBUT, and gender and oxygen saturation as predictors of OSDI. Although OSAS severity did not significantly affect objective dry eye measures or corneal sensitivity, subtle associations between tear production and corneal nerve function suggest possible subclinical ocular changes. Routine eye evaluations may benefit OSAS patients, especially those with risk factors like aging, smoking, and hypoxemia.

Epiretinal membrane (ERM) is a common condition causing visual deterioration. However, the indication and timing for the surgical treatment of this condition have not been standardized. In this study we aimed to evaluate the anatomical and functional outcomes of mild vs severe epiretinal membrane surgery across different stages and determine the optimal timing for surgical intervention using Govetto’s OCT-based classification. This retrospective study included 46 eyes undergoing pars plana vitrectomy for ERM. Patients were stratified according to severity into Stage 2 (n = 10), Stage 3 (n = 25), and Stage 4 (n = 11) based on SD-OCT findings. Pre- and postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central macular thickness (CMT) were analyzed. A short patient questionnaire was used to assess the subjective outcomes of the surgery. Stage 4 patients had significantly worse preoperative and postoperative BCVA compared to milder stages (p = 0.007). Structural OCT abnormalities such as ectopic inner foveal layers (EIFL), inner retinal irregularity (IRI), COST (cone outer segment tip) line defects and inner segment/outer segment (IS/OS) junction disruption were significantly more frequent in Stage 4. Stage 2 showed thinner CMT and significantly better visual outcomes postoperatively. Subjective visual improvement was most notable in Stage 3 (p = 0.032). ERM surgery in severe cases (stage 4) is associated with inferior anatomical and visual outcomes. Surgical intervention in milder cases particularly in stage 2, results in more favorable postoperative BCVA and reduced anatomical disruption. These findings support considering surgery in milder cases before the development of advanced OCT changes such as IS/OS disruption, EIFL and IRI.

To compare the intraoperative complication rates and incidence of postoperative day 1 (POD1) intraocular pressure (IOP) elevation in primary phacoemulsification cataract surgery performed by residents and staff surgeons in a teaching hospital and determine the risk factors associated with posterior capsule tear (PCT) and POD1 IOP elevation. This retrospective study included all cases of primary phacoemulsification in patients aged 18 years or older, performed by residents and staff surgeons from May 27, 2022, to May 31, 2023 in a tertiary eyecare center in Turkey. There were no exclusion criteria. Data collected included primary surgeon, level of experience, preoperative status of cases, intraoperative complications, other operative details and POD1 IOP measurements. A total of 1500 surgeries were included; 68.8

Objectives: This study compares the cosmetic and functional outcomes of corneal tattooing/keratopigmentation and ocular prostheses in rehabilitating disfigured eyes, focusing on esthetic appearance and emotional well-being. Methods: Ninety-two patients were included: 48 received corneal tattooing, and 44 were fitted with ocular prostheses. Anophthalmic surgery was indicated for trauma, painful blind eye, endophthalmitis, tumor, and corneal ulcer, while corneal tattooing was performed for trauma, corneal ulcer, and endophthalmitis. Comprehensive ophthalmic examinations, a seven-item satisfaction questionnaire, and assessments of ocular movement in four directions and postoperative complications (e.g., infection, enophthalmos, fornix loss, and eyelid disorders) were conducted. Results: Patients who underwent ocular cosmetic rehabilitation reported high satisfaction, with corneal tattooing yielding higher satisfaction rates across all measures (P<0.001). Patients with corneal tattooing exhibited significantly better ocular movement in all four cardinal directions (P<0.001 for temporal, nasal, superior, and inferior). The prosthesis group experienced more postoperative complications, including ocular surface disorders and structural anomalies. Conclusion: Corneal tattooing and ocular prostheses both provide viable options for rehabilitating disfigured eyes. Corneal tattooing offers advantages in ocular movement, fewer complications, and higher patient satisfaction, while ocular prostheses are more suitable for addressing phthisis bulbi, tumors, and ocular pain.

Purpose: This study investigated the bacterial and fungal contamination of preservative-free, multidose cyclosporine (PFMD-Cyc) bottles. Methods: One hundred PFMD-Cyc eye drops administered by different patients for a minimum of 3 weeks were analyzed. The caps and first and second drops from the bottles underwent microbiological testing using sheep blood agar, chocolate agar, Sabouraud dextrose agar, and Brucella broth media. Conjunctival cultures were obtained from patients whose bottles were contaminated. The residual drug inside the contaminated bottles was examined by drilling the bottles' underside. Results: Microbial contamination was detected in 47% (n = 47) of the samples, with both poly- and monomicrobial growth. Fifty-nine species (25 gram-positive and 11 gram-negative bacteria, 15 yeasts, and 8 molds) were identified in the contaminated bottles. The most prevalent microorganisms were Staphylococcus epidermidis (n = 11), Candida parapsilosis (n = 7), and Fusarium spp. (n = 4). Conjunctival cultures from 4 patients revealed the same pathogens identified in the contaminated bottle, including Serratia marcescens, Klebsiella aerogenes, Staphylococcus aureus, and Candida parapsilosis. Conclusions: In addition to bacteria, a particularly high level of fungal contamination was detected. Conjunctival microorganisms were also detected in select samples. Patients should be advised to practice proper hand hygiene before administering eye drops. Moreover, meticulous attention to the storage conditions of medications during treatment is essential. Furthermore, research into fungal contamination of ophthalmical solutions, particularly immunosuppressive eye drops, is warranted.

AIM:This study aims to investigate the psychosocial effects of corneal tattooing in patients with corneal leukoma. MATERIALS AND METHODS:Aesthetic pigmentation was applied to patients with corneal leukomas. The Hospital Anxiety and Depression Scale (HADS), Social Appearance Anxiety Scale (SAAS), and the International Brief Version of the Fear of Negative Evaluation Scale, which were validated by Turkish speakers, were performed before and 3 months after corneal tattooing for aesthetic purposes. A review and interpretation of questionnaire scores was conducted under the supervision of authors from psychiatric departments. For demographic and clinical data, 20 questions were asked of patients before tattooing and 14 questions were asked 3 months after tattooing. RESULTS:According to all tests, all scores drastically decreased after corneal tattooing. In the HADS test, the mean preoperative depression score was 8.80, while the postoperative was 4.39 ( P <0.001). The mean preoperative anxiety score was 7.52, and the postoperative score was 4.41 ( P <0.001). The mean preoperative SAAS score was 50.64, with the postoperative score equaling 33.68 ( P <0.001). Finally, the mean preoperative BNFES score was 35.14, and the postoperative was 24.57 ( P <0.001). All values are statistically strongly significant ( P <0.001). CONCLUSION:Patients with corneal leukomas are at higher risk of significant depression and anxiety symptoms for many reasons, such as low vision, trauma, multiple surgery, strabismus, and ptosis. In conclusion, addressing corneal leukoma through appropriate ophthalmological interventions not only improves visual function but also alleviates appearance-related psychological distress. Integrating psychiatric assessment into the care process may further enhance the overall quality of life through a holistic, patient-centered approach.

Purpose This study aimed to investigate the conjunctival microbiota of patients requiring intravitreal injections due to diabetic retinopathy (DR), age-related macular degeneration (AMD), and retinal vein occlusion (RVO). Methods A total of 182 participants (46 DR, 71 AMD, 16 RVO, and 49 controls) were enrolled between August and November 2024. Conjunctival swabs were collected from both eyes under sterile conditions prior to injection and cultured on 5% sheep blood and chocolate agar. Microorganisms were identified using Vitek MS. Results No significant differences were observed among the groups in overall microbial growth frequency (all p > 0.05). Gram-negative bacteria, fungi, and polymicrobial growth were more frequently detected in DR and AMD patients, suggesting a trend toward greater microbial diversity, although these differences were not statistically significant. Conclusion DR and AMD patients exhibited higher prevalence of gram-negative, fungal, and polymicrobial colonization. These findings underscore the importance of strict aseptic preparation, povidone-iodine disinfection, and targeted prophylactic strategies to minimize post-injection infection risk in high-risk populations.

BACKGROUND:This prospective study aimed to compare scleral needling with the conventional scleral massage technique for sclerotomy closure, using anterior segment optical coherence tomography (AS-OCT) to assess postoperative wound morphology. METHODS:Thirty eyes of 30 patients undergoing pars plana vitrectomy with a 25G vitrectomy system (Constellation; Alcon Laboratories, Fort Worth, TX, USA) were included. In each eye, one superior sclerotomy site (superonasal or superotemporal) was closed with scleral needling (Group A), while the other was closed with scleral massage (Group B), eliminating the impact of individual variability. RESULTS:Most sclerotomies (80%) could be closed with a single attempt of needling (mean 1.2 ± 0.4). The mean outer and inner sclerotomy incision diameters on the postoperative first day were 119 ± 22 and 94 ± 17 µm, respectively, for group A, and 118 ± 19 and 94 ± 16 µm, respectively, for group B ( P = 0.658 and 0.871, respectively). Sclerotomy wound diameters of both groups A and B decreased significantly on postoperative day 14 ( P < 0.001 and P < 0.001, respectively). None of the patients developed postoperative hypotony or any severe complication. A conjunctival bleb in four Group A patients resolved by day 3. CONCLUSION:The newly described scleral needling technique was as successful and safe as the conventional scleral massage technique. AS-OCT imaging also confirmed that scleral needling did not cause any disruption on wound morphology.

Introduction: Vitreoretinal surgery has advanced with transconjunctival sutureless vitrectomy (TSV), using smaller incisions. However, TSV often causes hypotony due to sclerotomy leakage, leading to severe postoperative issues. This study compares outcomes between sutureless and sutured 25G pars plana vitrectomy (PPV) and highlights sutures' significance in TSV. Methods: Fifty-four eyes underwent 25G PPV, divided into sutureless and sutured groups based on sclerotomy closure methods. Preoperative and postoperative evaluations at 1 week, 1 month, and 3 months included corrected distance visual acuity (CDVA), intraocular pressure (IOP), auto refractometer readings, and corneal topography. Special attention was given to postoperative hypotony, and surgically induced astigmatism (SIA) was assessed. Results: The sutureless (mean age: 67.4 +/- 9.1 years, n=31) and sutured (mean age: 59.2 +/- 12.7 years, n=23) groups were analyzed. The sutureless group showed stable SIA at 1 and 3 months (1.39 +/- 1.1 vs. 1.30 +/- 0.9, p=0.695). The sutured group had higher SIA at 1 month (3.16 +/- 3.2 vs. 1.39 +/- 1.1, p=0.009), which decreased by 3 months (3.16 +/- 3.2 vs. 1.95 +/- 1.4, p=0.021). No significant intergroup differences were observed at the third month postoperatively. CDVA improved significantly in both groups (p<0.001), highlighting surgical efficacy. IOP was comparable to that of the sutureless group, but transient hypotony occurred in the sutureless group. IOP consistency favored the sutured group. Conclusion: The study findings underscore the impact of suturing the sclerotomy ports on elevating SIA. However, it's crucial to note that SIA usually decreases by the third postoperative month, whereas hypotony-related complications can have enduring effects. Surgeons must carefully assess hypotony risks, particularly in children or in cases of high myopia, deciding on the necessity of sutures in microincisional PPV.

To investigate the effectiveness of preservative-free multi-dose eye drop technology in preventing contamination. Prospective study In this study, the caps, first and second drops of preservative-free multidose brimonidine (PF-MDB) and multidose brimonidine with purite preservative (P-MDB) used by 54 glaucoma patients were analysed on both chocolate and sheep blood agar. The patients used the drops at 3-week intervals. The contents of the eye droppers were examined for contamination by piercing the bottom of the eye dropper in accordance with aseptic techniques. The contamination levels detected using chocolate agar in the caps and the first drops of PF-MDBs were significantly higher than in P-MDBs (p=0.006 and p<0.001, respectively). The contamination levels detected using blood sheep agar in the caps and the first and second drops of PF-MDBs were significantly higher than in P-MDBs (p=0.001, ‹0.001, 0.006, respectively). No growth was found inside the eye dropper bottles of either PF-MDB or P-MDB drops. There was a significantly higher level of contamination in the first drops of PF-MDB compared to the second drops (p<0.001). PF-MDB bottle technology effectively prevents microbial contamination in the bottle without preservatives. However, due to the lack of a preservative, there is increased bacterial and fungal growth associated with contamination on the cap, as well as in the first and second drops, compared to P-MDB.

PURPOSE:This study presents a novel sutureless closure approach for sclerotomies following pars plana vitrectomy (PPV) and assesses its efficacy and safety. METHODS:A total of 142 eyes were included in the study. PPV procedures were performed using 23-gauge (23 G) or 25-gauge (25 G) systems. Preoperative characteristics, intraoperative findings, and postoperative outcomes were documented. RESULTS:The cohort included 80 males and 62 females (mean age: 60.4 ± 12 years), primarily undergoing surgery for retinal detachment (59%). Among the patients, 87% underwent 25 G PPV (35% three-port, 52% four-port), while 13% underwent 23 G PPV (12% three-port, 1% four-port). Gas tamponade was administered in all cases, with perfluoropropane used in 45.7% of instances, sulfur hexafluoride in 29.5%, and air in 24.6%. Spontaneous closure was observed in 9.4% (47 of 501) of sclerotomies, autologous-fibrin induction approach successfully closed 75.8% (380 of 501) of the sclerotomies (83.7% of leaking sclerotomies) and 14.7% (74 of 501) of sclerotomies needed sutures. Visual acuity improved postoperatively, and first-day hypotony rate was 6.3%. Importantly, no serious complications such as choroidal detachment or endophthalmitis were observed during the postoperative period. CONCLUSION:The autologous-fibrin induction offers a simple, cost-efficient, and reliable approach for sutureless sclerotomy closure in PPV, with promising outcomes.

To understand factors affecting visual prognosis and the number of intravitreal antivascular endothelial growth factor (anti-VEGF) injections needed to stabilize wet age-related macular degeneration (AMD). In this retrospective cohort, 119 treatment-naïve wet AMD patients were followed for two years. In patients with bilateral disease, the eye with worse best-corrected visual acuity (BCVA) or that received more intravitreal injections was recruited as the study eye. In all visits, BCVA was recorded, ophthalmological examination was performed including macular optical coherence tomography imaging. Twenty health status/lifestyle questions were asked to the patients via phone as potential risk factors. All patients received 3 loading doses of intravitreal bevacizumab injections and received repeat injections of aflibercept or ranibizumab when the eye had a new, active neovascular lesion. Patients who took regular micronutrition had similar visual outcome and injection numbers compared to the ones who did not. Patients with bilateral disease needed less intravitreal injections compared to unilateral AMD patients (p = 0.016) and women on hormone replacement therapy (HRT) required less injections compared to the women who were not (p = 0.024). Female patients had a mean gain of 2.7 letters while male patients lost 3.8 letters (p = 0.038). Wet AMD started at an earlier age in smokers (p = 0.002). Patients with a better education level presented earlier with better BCVA (p = 0.037). HRT and anti-VEGF injections to the fellow eye improved the prognosis of wet AMD, while male patients had slightly worse prognosis. Estrogen’s protective effects and potential contribution in wet AMD needs further attention. Retrospectively registered: 2020/0622.

Background: Bell’s phenomenon, also known as the palpebral oculogyric reflex, is a critical reflex that protects the cornea. We developed an innovative, simple, and practical grading scale for Bell’s phenomenon that includes the inverse Bell’s phenomenon. Using this scale, we investigated the characteristics of Bell’s phenomenon among asymptomatic individuals in different age groups and examined the frequency of ocular surface lesions in asymptomatic and symptomatic participants with different grades. Methods: Bell’s phenomenon was classified into five grades: grade +2 (strong positive), grade +1 (weak positive), grade 0 (no Bell’s phenomenon, no eye movement), grade –1 (weak inverse), and grade –2 (strong inverse). In this cross-sectional study, we randomly included 330 eyes of 165 asymptomatic, healthy, White Turkish individuals who attended the outpatient eye clinic, with a male-to-female ratio of 1:1.4, in the control group. These were categorized into four age groups: 4 – 20 years, 21 – 40 years, 41 – 60 years, and > 60 years. Eighty eyes from 40 patients with ocular surface lesions and absence of grade +2 Bell’s phenomenon were included in the symptomatic group. Results: We detected higher frequencies of grade +2, +1, and 0 in individuals aged 4 – 40, 41 – 60, and > 60 years, respectively. There was a significant difference between age groups in the frequencies of different grades (P < 0.001). Pairwise analysis revealed a significantly lower frequency of grade +2 in the age group > 60 years compared with the 4 – 20 and 21 – 40 year groups (both P < 0.05). Grade +2 was the most frequent in both sexes. We detected grade 0 in 27.1% of men and 22.1% of women in the control group, with no significant difference in the frequencies of different grades between sexes (P > 0.05). We observed significant differences between grades with respect to the frequency of ocular surface lesions (P < 0.001). Pairwise analysis revealed a significantly higher frequency of ocular surface lesions in asymptomatic individuals with grade 0 and all four other grades (all P < 0.001). However, the frequency of ocular surface lesions was comparable between sexes (P > 0.05). Of the 40 symptomatic individuals, 28 (70%), 5 (12.5%), 4 (10%), and 3 (7.5%) had grade 0, +1, –1, and –2, respectively. The number of symptomatic patients was higher in grade 0 (n = 28) than in other grades (grade +1, –1, and –2: n = 12 patients), and these individuals had a higher frequency of ocular surface lesions (n = 38 lesions) than others (grade +1, –1, and –2: 7 lesions). Conclusions: Using a simple, practical grading scale for Bell’s phenomenon that includes inverse Bell’s phenomenon, we observed that inverse Bell’s phenomenon is a reflex that may be present in healthy individuals and could have a protective effect on the eye, although not to such a degree as a strong Bell’s phenomenon. Our observations imply that bilateral conjunctival calcifications/Vogt’s limbal girdle may be associated with grades 0 and +1 Bell’s phenomenon. Further large-scale studies are needed to determine the frequency of Bell’s phenomenon in the general population using this innovative, simple, practical grading scale, and to identify the protective or injurious effect of each grade on the ocular surface.

Introduction: Dry eye is a common ocular condition causing discomfort and visual disturbances. Anti-inflammatory agents like Cyclosporine A (CsA) are often used in its treatment. However, the impact of CsA on ocular flora remains understudied. This research aimed to evaluate changes in conjunctival and nasal microflora in patients receiving topical cyclosporine for dry eye. Methods: In this cross-sectional study, conjunctival and nasal samples were collected from two groups of dry eye patients. Group 1 consisted of 38 patients using CsA eye drops, while Group 2 included 34 patients using preservative-free artificial tear drops. Bacterial cultures were grown from the samples, and the identified organisms underwent antibiotic susceptibility testing. Additionally, alpha diversity metrics were employed to assess the diversity of bacterial species in the samples. Results: Bacterial growth was observed in 75% of conjunctival samples and 97.22% of nasal samples. Staphylococcus epidermidis was the predominant organism in both groups. Alpha diversity analysis showed no significant differences in Shannon diversity and OTU richness between the groups for most bacterial species. Antibiotic susceptibility tests revealed no substantial variations in resistance patterns between the groups. Conclusion: This study provides valuable insights into the impact of CsA eye drops on conjunctival and nasal flora in dry eye patients. The findings suggest that CsA does not significantly influence the composition, diversity, or antibiotic resistance patterns of ocular flora. Long-term topical cyclosporine treatment for dry eye does not significantly impact conjunctival microflora or lead to antibiotic resistance. These results have important implications for the safe use of CsA in patients undergoing ocular treatments, particularly those at risk of intraocular infections.

PURPOSE:To compare corneal higher order aberrations (HOAs) in patients with epiphora caused by unilateral primary acquired nasolacrimal duct obstruction (PANDO) and their fellow eyes. METHODS:A total of 122 eyes of 61 patients with unilateral PANDO were included. Affected eyes were named as group 1 and contralateral eyes as group 2. The Munk score and fluorescein dye disappearance test (FDDT) were assessed. Corneal topographic and HOAs measurements were taken by Sirius topography. RESULTS:There were 47 female and 14 male patients. The mean keratometry was 43.84 ± 1.4 in group 1 and 43.96 ± 1.4 in group 2 (p = 0.73). The mean corneal topographic astigmatism was 0.81 ± 0.7 in group 1 and 0.78 ± 0.5 in group 2 (p = 0.57). The mean coma-like aberration was 0.19 ± 0.2 in group 1 and 0.10 ± 0.1 in group 2 (p = 0.03). The mean spherical-like aberration was 0.16 ± 0.1 in group 1 and 0.11 ± 0.1 in group 2 (p = 0.04). The mean total corneal HOA was 0.30 ± 0.5 in group 1 and 0.23 ± 0.2 in group 2 (p = 0.04). The mean Munk score was 3.47 ± 1.0 in group 1. There was a positive correlation between the Munk score and both coma-like aberration (r = 0.53, p = 0.003) and total corneal HOAs (r = 0.44, p = 0.010). The mean FDDT grade was 2.60 ± 0.1 in group 1. A positive correlation was observed between the FDDT grade and both coma-like aberration (r = 0.48, p = 0.001) and total corneal HOAs (r = 0.33, p = 0.001). CONCLUSIONS:Epiphora in patients with PANDO can affect corneal HOAs. As patients' symptoms and tear pooling were increased as corneal HOA levels increased.

Evaluation of anterior segment parameters using the Scheimpflug corneal topography 1 year after surgery in patients who underwent sutureless scleral fixation intraocular lens (SFIOL) implantation using the modified Yamane technique and retropupillary iris-claw intraocular lens (RPIOL) implantation. A total of 60 eyes from 57 patients who underwent sutureless SFIOL implantation and 57 eyes from 52 patients who underwent RPIOL implantation were included. Anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), anterior–posterior corneal astigmatism, and keratometric values were assessed using the Scheimpflug corneal topography (Pentacam HR, Germany). There was no statistically significant difference in postoperative UCVA and BCVA between the sutureless SFIOL and the RPIOL group (p = 0.236, p = 0.293, respectively). While there was no statistically significant difference in postoperative IOP between the two groups (p = 0.223), a statistically significant decrease in IOP was observed in both groups (p < 0.001). While there was no statistical difference between the sutureless SFIOL group and the RPIOL group in terms of spherical value (p = 0.441) and spherical equivalence (p = 0.237), there was a statistically significant difference in cylindrical value (p < 0.001). While there was a statistical difference in anterior astigmatism (p < 0.001), there was no statistical difference in posterior astigmatism (p = 0.405). There was no statistical difference in terms of ACV, ACD, and ACA between the sutureless SFIOL and the RPIOL group (p = 0.812, p = 0.770, p = 0.401, respectively). In this study, although there was a statistical difference in cylindrical value and anterior corneal astigmatism between the sutureless SFIOL and RPIOL groups, vision was not affected. According to this study, sutureless SFIOL and RPIOL are two successful methods in terms of visual acuity, anterior segment, and keratometry outcomes in aphakic patients after phacoemulsification.

PurposeThis study aimed to investigate the effects of commercial tattoo inks used in corneal tattooing on conjunctival microbiota.MethodThis prospective case control study consisted of 125 participants divided in the following three groups: 35 patients with corneal tattoos, 40 patients with corneal leukoma, and 50 healthy subjects. Corneal tattooing was performed in all the cases in this study using a tattoo pen machine and commercial tattoo ink. A total of 500 cultures were taken from 250 eyes of 125 individuals on chocolate and sheep blood agar. Bacteriological samples were taken from the inferior eyelid conjunctiva using a sterile cotton swab. Without any contact elsewhere, the swabs were smeared on bedside chocolate agars and 5% sheep blood agar.ResultsIn tattooed eyes, bacterial growth was detected in 42.9% of the chocolate and sheep blood agar samples. In other healthy eyes of patients with corneal tattoos, 54.5% bacterial growth on chocolate agar and 57.1% on sheep blood agar were detected. No statistical difference was detected in the conjunctival microbiota of chocolate and sheep blood agar (p = 0.254, p = 0.134, respectively) in the tattooed eyes compared to the other eye of the individual. No statistically significant difference was found in terms of bacterial growth in tattooed, leukoma, or healthy eyes on chocolate and sheep blood agar (p = 0.408, p = 0.349). The growth rate of Staphylococcus epidermidis decreased by 33.3% (from 12 to 8) on chocolate agar in 35 tattooed eyes, and it decreased by 28.5% (from 14 to 10) on sheep blood agar, while gram-negative bacteria Brevundimonas diminuta, Acinetobacter lwoffii, and Psychrobacter faecalis were detected in three patients.ConclusionCorneal tattooing using commercial dye does not affect conjunctival microbiota. In the past 3 years, 120 patients have been tattooed with commercial tattoo ink in Istanbul Medeniyet University Goztepe Training and Research Hospital. No complications related to infection were found in the 3-year follow-up. The gram-negative bacteria detected in the healthy control group and tattooed eyes were bacteria found on normal skin or in the respiratory tract. Although some gram-negative bacteria do not cause infection, careful eye examination, follow-up, and culture are required in suspicious cases.

Purpose: This study aimed to investigate the bacterial contamination of multi-use tear drops, gels, and ointments that patients use at home.Method: A total of 271 multi-use containers used by 168 patients were examined. Conjunctival culture samples were obtained from patients who used tear drops, gels, and ointments that were found to be contaminated.Results: Bacterial contamination was detected in 33 (12.2 %) out of the 271 containers. The contamination rate was 7.9 % in tear drops, 11.7 % in gels, and 32 % in ointments. A statistically significant difference was found between the drops, gels, and ointment groups (P = 0.04). Bacterial contamination was detected in 25 (18.9 %) out of 132 collapsible tubes and 8 (5.8 %) out of 139 plastic bottles (P = 0.01). Important bacteria, including Pseudomonas stutzeri, Pseudomonas aeruginosa, Bacillus licheniformis, Paenibacillus pabuli, Proteus mirabilis, Pantoea agglomerans, Morganella morganii, Serratia marcescens, and Serratia liquefaciens, were detected. Mucorales spp. fungus was seen in a gel. Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus, and M. morganii were found in the conjunctival microbiota of three patients.Conclusion: The overall contamination rate of ocular lubricants was low (12.2%); however, a significant difference was found between the drops, gels, and ointments. The contamination rate was higher in gels and ointments than that in drops. The contamination rate was found to be increased in the collapsible tube. The use of ocular lubricants is safe; however, patients must be cautious when using multi-use tear drops, gels, and ointments to avoid contamination. Whenever possible, bottles should be preferred instead of collapsible tubes.