Moderator
Leela Raju, MD, ABO
Panelists
Saba Al-Hashimi, MD
Arun C. Gulani, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Jennifer M. Loh, MD, ABO
Co-Authors
Brandon Ayres MD, Marc Bloomenstein OD, Thomas Chester OD
Purpose
To demonstrate the safety and long-term effectiveness of localized heat therapy (LHT) (TearCare, Sight Sciences) compared to cyclosporine (0.05%) ophthalmic emulsion (CsA) BID (Restasis, Allergan) to treat the signs and symptoms of dry eye disease.
Methods
SAHARA was a prospective, multicenter, IRB approved RCT. Eligible patients ?22 years of age with reported dry eye symptoms within the past 3-6 months were enrolled. In phase 1, patients were randomized to LHT or CsA (1:1) and followed for 6 months. In phase 2, all patients on CsA discontinued CsA, were treated with LHT, and followed for an additional six months. Phase 3 assessed the durability of the LHT treatment effect out to 24 months. Outcome measures included Tear Break-up Time (TBUT) of ?1 to ?7 seconds in both eyes, total Meibomian Gland Secretion Score (MGSS) ?12 in each eye, and Ocular Surface Disease Index (OSDI) score of 23-79 taken at week 1 and months 1, 3, 6, 12, and 24.
Results
345 enrolled and randomized. LHT showed statistically superior improvements from baseline in TBUT, MGSS, and all measures of meibomian gland function vs. CsA at 6 months (P?0.004) and was found to be non-inferior to CsA in OSDI (P=0.9843). Patients previously on CsA improved TBUT by 1.1 and 0.6 seconds at months 9 and 12, both of which were significantly better than crossover baseline (P<0.001). mgss="" was="" 13.4="" (8.3)="" after="" csa="" treatment="" which="" improved="" to="" 17.4="" (8.8)="" and="" 16.1="" (9.0)="" at="" 9="" and="" 12="" months=""><0.0001). osdi="" was="" 50.0="" (baseline),="" 34.2="" at="" 6="" months,="" 30.0="" and="" 31.0="" at="" 9="" and="" 12="" months="" (p="0.162" vs.="" month="" 6;=""><0.0001 vs.="" baseline).="" at="" 24="" months,="" 37="" of="" 161="" patients="" required="" lht="">
Conclusion
SAHARA showed superiority of LHT to CsA in clinical signs associated with DED. Moreover, patients previously treated with CsA demonstrated additional clinically meaningful improvements when crossed over to LHT. Finally, the extension through 24 months demonstrated durability of effectiveness with LHT resulting in few retreatments.
Presenting Author
Melissa M. Toyos, MD, FACS
Co-Authors
Rolando Toyos MD
Purpose
The purpose of the trial was to evaluate the effect of subcutaneous glp-1 agonists taken for weight loss on the subjective measurement of frequency and severity of symptoms of Dry Eye Disease in patients with pre-existing dry eye disease.
Methods
This was a prospective study, single-arm pilot trial of 11 consecutive subjects with pre-existing dry eye disease with no control measuring vas scores of subjective frequency and severity of dry eye disease. Subjects were assessed at baseline, at 4 weeks and 12 weeks. Patients self-injected various amounts of semaglutide subcutaneously once weekly and any concomitant dry eye medications were continued and not washed out.
Results
Mean baseline frequency was measured at 62.4 and mean baseline frequency was 64.2. At 4 weeks, mean frequency was 46.4 and mean severity was 44.5. At 12 weeks mean frequency was 33.6 and mean severity was 26.9. The mean reduction of frequency of symptoms from baseline over 12 weeks was 52.9% and the reduction of severity was 42.9% even in a patient with Sjogrens and a patient with psoriatic arthritis on stable doses of adalimumab. Pvalues to follow. Anecdotally, patients reported significant improvement at 4 weeks with less nighttime dry eye, fewer eye drops, less eye watering and redness.
Conclusion
GLP-1 agonists trigger the AMPK pathway reducing inflammation locally, systemically and in neuroinflammation. It suppresses pro-inflammatory cytokines, chemokines and reduces apoptosis. It regulates microglia function and polarization. GLP-1 agonists may have a role in reducing inflammation in patients with dry eye.
Presenting Author
Dror Ben Ephraim Noyman, MD, BSc
Co-Authors
Margarita Safir MD, Michael Mimouni MD, Itamar Arbel MD
Purpose
Various antibiotic treatments for meibomian gland dysfunction (MGD) are available, differing in administration and class, Thus, beyond ocular disease potentially impacting also systemic health, and community-related bacterial immunity. This review aims to assess the efficacy and safety of oral doxycycline versus topical macrolides in treating MGD.
Methods
A systematic search of electronic databases was performed for all published studies which included clinical outcomes of oral versus topical antibiotic MGD treatment, measuring at least one subjective symptom outcome or one clinical outcome for assessment of MGD numerically. Study reports were graded for risk of bias, and study data were extracted and evaluated in a weighted pooled meta-analysis, in accordance with the Cochrane society's guidelines
Results
3484 studies were found, of which 6 RCTs were ultimately included in the analysis. These reported on 374 patients from 6 countries, aged between 26-80 years. Overall, both treatment methods induced improvement in MGD signs and symptoms. Topical macrolides were significantly superior in the total symptoms score: Odds Ratio = 1.62, 95% confidence interval: [1.00, 2.63]. Several clinical outcomes showed significant favorability of 1% concentration topical azithromycin only in sensitivity analysis, but not in the total analysis. No severe complications were reported for both treatments. Risk for adverse events causing patient drop-out showed insignificant difference between the treatments.
Conclusion
MGD treatment protocols vary and are often based on personal preference rather than high quality data. This is the first meta-analysis comparing topical macrolides and oral tetracyclines. While both were found effective treatments for MGD, the former exhibited better control of symptoms and should be more positively considered in MGD management.
Presenting Author
Young Joon Choi, MD, PhD
Purpose
Amniotic membrane transplantation (AMT) during the acute phase of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) is known to reduce chronic phase ocular complications. This study investigates the long-term outcomes of patients with acute SJS/TEN who were treated with topical tacrolimus instead of undergoing AMT.
Methods
This study retrospectively investigated patients diagnosed with SJS/TEN who were referred to the Department of Ophthalmology at Ajou University Hospital from March 2020 to September 2023 and underwent follow-up observation for at least 6 months. Patients were treated with topical tacrolimus ointment four times daily along with antibiotic eye drops, steroid eye drops, and artificial tears from the time of diagnosis, and their progress was monitored.
Results
A total of 9 eligible patients out of 13 were included in the study. The mean age was 45.6 years (range: 11-71), with 5 patients diagnosed with TEN and 4 with SJS. The mean acute systemic severity score was 6.1 (range: 4-8), and the mean acute ocular severity score was 1.67 (range: 1-2). Regarding chronic complications, Mucocutaneous junction involvement was observed in 5 patients, meibomian gland involvement in 5 patients, and Trichiasis in 1 patient. The mean chronic ocular complication score was 1.2 (range: 0-3). Other chronic ocular complications such as conjunctival adhesion, loss of palisade of Vogt, or corneal opacity were not observed.
Conclusion
The use of topical tacrolimus ointment in acute SJS/TEN patients with ocular complications effectively reduced the incidence and severity of chronic ocular complications even without amniotic membrane transplantation during the acute phase.
Presenting Author
Veatriki Athanasiou, MBBS
Co-Authors
Sotiria Palioura PhD, MSc, MD, Konstantina Bachtalia MSc, Aikaterini Athanasiadou MSc
Purpose
To assess the efficacy of a conjunctival inflammation grading scale paired with a stepladder treatment strategy in managing biopsy-proven ocular MMP.
Methods
Prospective study of 48 patients (96 eyes) with biopsy-confirmed ocular MMP meeting the Tauber/Foster staging criteria on presentation assessed with a conjunctival inflammation grading scale before and after implementing a tiered treatment approach based on disease severity. Data collected spanned from 2017 to 2024, encompassing clinical findings, biopsy results, disease staging, treatment responses, and side effects of immunosuppression among others.
Results
Disease activity at presentation, assessed by a 0-4 scale in four quadrants, ranged from minimal (8.33%) to mild (57.29%) to moderate (16.67%) to severe (17.71%). Treatment varied with severity; moderate to severe cases received intravenous cyclophosphamide or rituximab, while milder cases were treated with oral mycophenolate mofetil. The post-treatment level of conjunctival inflammation ranged from minimal (57.29%) to mild (42.70%), with recurrences and complications from immunosuppression managed effectively.
Conclusion
This study is the largest cohort of patients with biopsy-positive MMP and the first to use a grading scale based on active inflammation rather than ocular surface scarring for treatment intensity decisions. It demonstrates that a stepladder therapeutic approach and varied immunosuppressive agents can effectively control ocular MMP.
Presenting Author
John A. Hovanesian, MD, FACS
Purpose
To evaluate corneal sensitivity in a cross-section of patients with signs of dry eye disease (DED) detected as an incidental finding during a cataract consultation.
Methods
We tested corneal sensitivity with a Cochet-Bonnet esthesiometer on patients who presented for cataract evaluation and were found to have corneal staining and a reduced tear breakup time (TBUT). Patients were excluded if they had contact lens wear, eyelid abnormalities, prior trauma, or any condition that would predispose to reduced corneal sensation.
Results
Among 31 dry eye patients evaluated, 18 (58%, 95% CI 39-75%) had sensation reduced below 4 cm, qualifying as stage 1 neurotrophic keratopathy. Of these, 13 (42%) had sensation of ? 3.5 cm, and 3 (10%) had sensation ? 3.0 cm. Three (10%) patients had diabetes,
Conclusion
Over half of patients presenging with the incidental finding of dry eye during cataract consultation had stage 1 neurotrophic keratopathy. Where ocular surface optimization is desired, surgeons shoudl consider the possible presence of reduced sensation when evaluating these patients for treatment.
Presenting Author
Nikhith Rao, None
Co-Authors
David Morcos BA, Olivia Lee MD, Jose Giraldo MD, Tara Shooshani MS, Miel Sundararajan MD, Jose Arthur Milhomens Filho MD, Ren� Caro BSc
Purpose
Topical Losartan has been suggested as a treatment for corneal scarring, but little evidence has been reported regarding clinical efficacy in humans. Using ocular imaging, this study describes the therapeutic effectivity of topical Losartan in a series of patients with corneal scarring secondary to infectious keratitis (IK).
Methods
We conducted a retrospective chart review of patients at two academic eye centers treated with topical Losartan (0.8 mg/mL every 2 hours) for a minimum of 2 months for post-IK corneal scarring between 2024-2025. The best spectacle corrected vision, slit lamp photos, corneal densitometry, anterior segment-OCT (AS-OCT), and in vivo confocal microscopy (IVCM) were assessed before and at each month after treatment initiation. T-tests were used to compare changes in the collected measures.
Results
Nine eyes from 9 patients ages 18 to 71 (mean: 52.8) with corneal scarring secondary to resolved IK. Three eyes were excluded due to inadequate follow-up or testing. The etiologies of infectious keratitis were viral (n=2), bacterial (n=2), and amoebic (n=2). After 2 months of treatment, all eyes showed reduced scar surface area evaluated via digital slit lamp photos. Visual acuity (LogMAR) improved in 66% of eyes by an average of 0.51 (0-0.92, p=0.15). In 4 eyes, corneal densitometry improved (12.6%-41.5%, p=0.59). Stromal reflectivity on IVCM decreased by a mean of 24.4% (p=0.12) from baseline to the latest follow-up. AS-OCT illustrated variable changes in scar reflectivity.
Conclusion
After two months of treatment with Losartan, patients with corneal scarring showed signs of improvement although the results were variable. Longer duration of treatment will be evaluated. Losartan�s potential therapeutic benefits as a medical, non-invasive treatment option are valuable as an alternative to surgical intervention.
Presenting Author
David L Wirta, MD
Co-Authors
Gary Jerkins MD, James Paauw MD, Sonya Bamba MD, Samir Melki PhD, MD, Michelle Senchyna PhD
Purpose
In 2 pivotal Ph3 studies (COMET-2 [C2] and COMET-3 [C3]), acoltremon 0.003% (ACO) met the primary endpoint by demonstrating a rapid increase in tear production based on the % of subjects achieving ?10mm increase in the unanesthetized Schirmer test (ST) at day (D) 14. In this study, we further investigate the impact of ACO on tear production.
Methods
C2 and C3 enrolled subjects aged ?30 years with signs and symptoms of dry eye disease (DED) of prespecified levels. All qualified subjects at screening received vehicle (VEH) in both eyes (OU) BID for 14 days. At baseline, subjects were randomized 1:1 to receive ACO or VEH, administered BID OU for 90 days. Tear production was assessed with the ST at all visits starting on D1. Post hoc analyses explored the % of subjects who achieved �normal� or greater tear production (defined as achieving an ST score ?10mm) at each visit in both the intent-to-treat (ITT) population as well as in a subpopulation (sPOP) of subjects with low baseline (2-5mm) ST using the Pearson chi-square test.
Results
On D1, high response rates in favor of ACO were observed in the ITT population: C2 (N=465), 64.8% vs 33.6% (P<0.0001); and="" c3="" (n="467)," 81.0%="" vs="" 41.9%=""><0.0001), aco="" vs="" veh="" respectively.="" similar="" high="" response="" rates="" in="" both="" studies="" were="" consistently="" observed="" throughout="" d90,="" yielding="" treatment="" differences="" in="" favor="" of="" aco="" vs="" veh="" ranging="" from="" 31.2%="" to="" 46.6%="" (all=""><0.0001). in="" the="" spop,="" higher="" response="" rates="" in="" favor="" of="" aco="" vs="" veh="" were="" again="" observed="" d1="" (c2:="" 53.6%="" vs="" 20.0%="" [aco="" vs="" veh;=""><0.0001]; and="" c3:="" 78.8%="" vs="" 21.9%="" [aco="" vs="" veh;=""><0.0001]) through="" d90,="" yielding="" treatment="" differences="" across="" both="" studies="" in="" favor="" of="" aco="" vs="" veh="" ranging="" from="" 30.1%="" to="" 56.9%="" (all="">< />
Conclusion
Normal tear production is essential for ocular surface homeostasis. In both Ph3 studies, ACO led to a high % of subjects achieving �normal� or greater tear production as early as D1. This clinically relevant outcome was observed in the ITT population and those with low baseline ST, further supporting ACO as a potential new treatment option for DED.
Presenting Author
Kendall E. Donaldson, MD, MS, ABO
Co-Authors
Elizabeth Yeu MD, James Mun PhD, Aimee Edell MD, Kavita Dhamdhere MD, PhD, Yuna Rapoport MD
Purpose
To characterize the burden of Demodex blepharitis (DB) through patient-reported outcomes, understand the current landscape and challenges in disease management, and measure potential changes in patients� outcomes after initiation of new therapy.
Methods
In this ongoing, real-world, multicenter registry study, patients aged 18 to 85 with a diagnosis of DB for at least 1 month were enrolled by their eye care provider. Patients were asked to complete web-based questionnaires at baseline and subsequently at months 1, 3, 6, 9, and 12. Demographic information, symptoms, treatments, and their impact on daily activities were recorded and analyzed.
Results
447 patients (mean age of 52 [range 18-83], 61% females) were enrolled from 20 US eyecare clinics. 91% of patients were symptomatic. 68% of the patients were on at least 1 over-the-counter option, including tea tree eyelid cleanser (32%), artificial tears (27%), and warm eye compress (25%). 41% of patients were on at least 1 prescription medication, with lotilaner ophthalmic solution, 0.25% being the most utilized (30%). Among patients who completed 1-month follow-up, DB-related symptoms (i.e., itchy eyelids, crusted eyelashes) and daily activities were significantly improved for those who were on lotilaner ophthalmic solution, 0.25% vs. those who were not.
Conclusion
The results demonstrate the significant disease burden of DB. Longitudinal data from more patients will provide further understanding of the disease burden and the impact of lotilaner ophthalmic solution, 0.25% on patients with DB.
Presenting Author
Ghada Aljuhani, MBBS
Co-Authors
Abdulrahman Alahmadi MBBS
Purpose
Epithelial basement membrane corneal dystrophy (EBMD) is the most common type of anterior corneal dystrophy. Literature on the surgical management of refractory cases in which medical treatment fails is scarce and requires development. The objective of this study was to systematically review current data on surgical options for EBMD.
Methods
This search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed and Cochrane databases in August 2023. We used the following mesh words: epithelial basement membrane dystrophy, map-dot fingerprint dystrophy, EBMD, AND surgical or surgery.
Results
Our meta-analysis assessed phototherapeutic keratectomy (PTK), diamond burr (DB), mechanical epithelial debridement, and cocaine-assisted epithelial debridement. The total pooled recurrence rate was 13.74% (95% CI 5.687-24.585); the recurrence rate was 20.61% in the PTK and 4.47% in the DB studies. In the PTK group, 4.89% of the patients lost one or more lines of BCVA (95% CI 0.624 to 12.876), while in the DB group, 4.760% of the patients lost one or more lines of BCVA (95% CI 0.946 to 11.275). Among the reported complications, haze formation was the most common complication across the different surgical treatments, with the highest haze incidence in the PTK group.
Conclusion
In conclusion, our review and meta-analysis showed that the DB approach had the lowest recurrence rate and haze incidence among all other surgical management methods. Furthermore, the pooled proportion of patients who lost one or more lines of BCVA was 4.162%, indicating that the surgical intervention for EBMD is generally safe.
Presenting Author
Ailin Song, MD
Co-Authors
Jay Lusk MD, MBA, C. Ellis Wisely MD
Purpose
Recent guidelines in emergency medicine support the safety of short-term topical anesthetic (TA) use for simple corneal abrasion (CA). Ophthalmologists have raised concern about this practice as TA misuse can result in toxic keratopathy. This study aims to evaluate the association between TA prescription for CA and 5-year adverse corneal outcomes.
Methods
A retrospective cohort study was performed using data from the National Institutes of Health All of Us Research Program to determine the association between TA prescription and adverse corneal outcomes in 5 years among participants with CA. Outcomes of interest were 1) diagnosis of any type of corneal ulcer, epithelial defect, corneal edema, stromal infiltration, corneal abscess, corneal melt, or corneal scar; 2) procedures including any type of keratoplasty, keratoprosthesis, amniotic membrane, ocular surface reconstruction, tarsorrhaphy, and corneal patch graft. Cause-specific hazard models were used to model outcome-free survival among participants with vs without TA exposure.
Results
Among 3,941 participants with corneal abrasion, 273 were prescribed TA for outpatient use. No significant baseline difference in age, gender, race, Elixhauser Comorbidity Index, history of corneal conditions, and contact lens use existed between the groups. The unexposed group had more eyedrop prescriptions (SMD=0.216), eye care visits (SMD=0.425), and eye procedures (SMD=0.223) in the year preceding CA (all p<0.001). after="" adjustment="" for="" the="" above="" baseline="" variables,="" ta="" prescription="" was="" not="" significantly="" associated="" with="" diagnosis="" of="" adverse="" corneal="" outcomes="" in="" 5="" years="" (adjusted="" hazard="" ratio="" 0.87="" [95%="" ci,="" 0.44-1.71],="" p="0.68)." no="" in="" the="" ta="" group="" had="" a="" procedure="" of="" interest="" in="" 5="">
Conclusion
This study did not find an association between TA prescription for CA and adverse corneal outcomes within 5 years. Notably, residual confounding due to differential prescription of TA by CA severity and/or baseline risk of adverse outcomes cannot be excluded. Further studies accounting for these factors are needed.
Presenting Author
Sophie X. Deng, MD, PhD, ABO
Co-Authors
Duangratn Niruthisard MD, Clemence Bonnet MD, PhD, FEBO, Simon Fung MA, MD, FRCOphth
Purpose
To investigate whether neurotrophic keratopathy is present in limbal stem cell deficiency (LSCD) by measuring corneal sensation and characterizing corneal subbasal nerve plexus.
Methods
Forty-six eyes with LSCD and 14 normal eyes were recruited from 2019 to 2022. Corneal sensation was measured using a Cochet-Bonnet esthesiometer and subbasal nerve plexus was imaged using in vivo confocal microscopy (IVCM) at the central cornea and 4 limbal regions. Subbasal nerve density (SND, number of nerve/mm2), subbasal nerve length (SNL, total length of nerve/mm2) and subbasal nerve branch density (SNBD, number of branch/mm2) were quantified. LSCD was graded to stage 1, 2 and 3 using a previously established staging method` consisting of clinical scores, basal cell density, central corneal epithelial thickness and SNL.
Results
The mean cornea sensation in the central cornea and limbus were 29.2 � 21.5 and 33.6 � 15.1 mm in the LSCD group and 57.6 � 5.8 and 54.3 � 4.7 mm in the control group, respectively (all P < 0.001). In sectoral LSCD, the sensation in the affected regions (29.1 � 17.6 mm) decreased compared to the unaffected regions (41.4 � 18.2 mm, P < 0.001). Central corneal SND, SNL and SNBD were reduced by 84.6%, 82.6%, and 89.2%, respectively in LSCD compared to the control (all P < 0.05). The central corneal sensation negatively correlated with the severity of LSCD (rho = -0.64, P < 0.0001) and positively correlated with SND, SNL, and SNBD (rho=0.63, 0.66, and 0.56, respectively; all P < 0.001).
Conclusion
Corneal sensation was reduced in eyes with LSCD. The degree of corneal sensation reduction positively correlated with the severity of LSCD. This finding demonstrated the co-existence of neurotropic keratopathy in LSCD.
Presenting Author
Wendy J Li, BSc
Co-Authors
Michael Antonietti BSc, Allister Gibbons MD, Carol Karp MD, Wisam Najdawi BSc, Diego Alba MD
Purpose
To evaluate the cost-effectiveness of primary treatments for ocular surface squamous neoplasia (OSSN) by comparing surgical excision with cryotherapy to topical 5-fluorouracil (5-FU) eye drop therapy.
Methods
We assessed the cost effectiveness of topical 5-FU eye drops compared to excisional surgery with cryotherapy as the primary treatment for OSSN using a disease simulation model. Data from the Center for Medicare and Medicaid Services were utilized to estimate the costs associated with each treatment in a non-facility setting, from the perspective of a third-party payer. The cost-effectiveness was evaluated by analyzing the total costs and clinical outcomes of each modality over a one-year period.
Results
We created an algorithm using TreeAge software to analyze the total costs associated with 5-FU medical therapy compared to surgical excision with cryotherapy and amniotic membrane transplant. The cost for medical therapy with 5-FU included medications, imaging, office visits for one year, and when necessary, rescue medical or surgical therapy. The cost for surgical excision included operating room time, anesthesia, surgeon fees, pathology analysis, post-operative medications, office visits for one year, imaging, and when needed, repeat surgery or adjuvant medical therapy. Topical 5-FU eye drop therapy resulted in an average cost saving of $3,642 per case.
Conclusion
On average, surgical excision was over four times more expensive than medical therapy with 5-FU. These savings persisted across the sensitivity analysis. Initiating topical 5-FU eye drops offers the greatest cost-effectiveness compared to primary surgical excision with cryotherapy in this treatment model of OSSN.
Presenting Author
Ana F. Balbuena-Pareja, MD
Co-Authors
Chloe Bogen MS, Stephanie Cox OD, Pedram Hamrah MD
Purpose
To assess corneal nerve alteration by in vivo confocal microscopy (IVCM) in patients with different stages of neurotrophic keratopathy (NK), and to compare results with healthy controls, and patients with dry eye disease (DED), and neuropathic corneal pain (NCP).
Methods
This retrospective, single center, cross-sectional study included patients with stage 1 (n=24), stage 2 (n=4), and stage 3 (n=2) NK, healthy controls, DED, and NCP patients seen at New England Eye Center that had IVCM available for analysis. For each visit, 3 representative IVCM images were selected by one observer and graded by two masked observers for total nerve density using ImageJ/NeuronJ. Results from NK patients were compared to age-matched patients with DED, NCP patients, and healthy controls selected from a database. Unpaired tests were used to compare the NK group, healthy controls, DED, and NCP groups.
Results
The NK group (n=30; age:62.4�18years; 18.0% male), control group (n=10; age:51.3�8.2y), DED group (n=27; age: 53.9�17.0y), NCP group (n=21 age:54.4�19.0y) did not differ in age (p>0.05). Median (range) total corneal nerve density in mm/mm2 decreased with advanced stages of NK, stage 1 [2.55 (0.00-14.96)], stage 2 [0.00 (0.00-2.27)], and stage 3 [0.00 (0.00-0.00)], p=0.081. Median (range) total nerve density was significantly lower in overall NK group [1.01 (0.00-14.96)], compared to controls [18.31 (14.94�21.00) mm/mm2, p<0.001], ded="" [10.11="" (0.00-18.41)="" mm/mm2,="" p="0.001]," and="" ncp="" [14.88="" (9.32�19.98)="" mm/mm2,=""><0.001]>
Conclusion
Although NK stage 1 patients can have overlapping signs with DED, severe loss of nerves assessed by IVCM could aid in the diagnosis of early-stage NK. Moreover, the extremely low nerve density in NK stage 1 demonstrates late-stage neurodegenerative disease at the time of diagnosis, despite �early-stage� clinical disease.
Presenting Author
Lital Smadar, MD
Purpose
Blepharitis (37%-46% prevalence) and lower eyelid ectropion (2%-3% prevalence) are common ocular conditions. Blepharitis involves anterior and posterior eyelid inflammation, while ectropion causes ocular surface exposure, epiphora, and chronic conjunctivitis. This study investigates a possible association between these conditions.
Methods
This retrospective cohort study analyzed the medical records of 37,692 consecutive patients examined at a single medical screening center between 2001-2020. The study aimed to determine the prevalence of lower eyelid ectropion and blepharitis, investigate any possible association between the two conditions, and assess the relationship of each with age and sex.
Results
A total of 35,670 patients were included. Lower eyelid ectropion was diagnosed in 69 patients (0.2%), and blepharitis in 4725 patients (13.2%). Male sex was more prevalent for each pathology (88.4% ectropion, and 85% blepharitis, P < 0.001). Older age was associated with each diagnosis (77.3 years for ectropion patients vs. 52.2 years for the general screened population and 60.5 years for blepharitis patients vs 52.2 years for the general screened population P < 0.001). The prevalence of lower eyelid ectropion was significantly higher in patients with coexisting blepharitis compared to those without (0.8% vs. 0.1%, respectively, P < 0.001).
Conclusion
Lower eyelid ectropion was significantly more prevalent in patients with blepharitis. Both conditions were associated with older age and male sex. This coexistence can aid in decision making of early surgical intervention of lower eyelid ectropion as well as the approach to medical treatment of blepharitis.
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