Purpose To assess the use of ultra high resolution optical coherence tomography (UHR-OCT) in the diagnosis of ocular surface lesions. Design Prospective, non-comparative, interventional case series. Participants Fifty four eyes of 53 consecutive patients with biopsy proven ocular surface lesions; 8 primary acquired melanosis, 5 amelanotic melanoma, 2 nevi, 19 ocular surface squamous neoplasia, 1 histiocytosis, 6 conjunctival lymphoma, 2 conjunctival amyloidosis, and 11 pterygia. Intervention UHR-OCT imaging of the ocular surface lesions. Main Outcome Measures Clinical course and photographs, UHR-OCT image and histopathological findings. Results UHR-OCT images of all examined ocular surface lesions showed close correlation with the obtained histopathological specimens. When clinical differential diagnosis of ocular surface lesions was broad, UHR-OCT images provided optical signs that guided towards a more specific diagnosis and management. In cases of amelanotic melanoma, conjunctival amyloidosis, and primary histiocytosis and in one case of ocular surface squamous neoplasia, UHR-OCT was instrumental in guiding the diagnosis. In those cases, UHR-OCT suggested that the presumed clinical diagnosis was incorrect and favored a diagnosis which was later confirmed by histopathological examination. Conclusions Correlations between UHR-OCT and histopathology confirm that UHR-OCT is an adjunctive diagnostic modality that can provide a non-invasive means to help and guide diagnosis and management of ocular surface lesions.

Abstract.Seasonal allergic conjunctivitis (SAC) is an inflammatory response of the conjunctiva triggered by exposure to seasonal allergens. Treatment options for SAC include artificial tears, antihistamines, decongestants, mast cell stabilizers, nonsteroidal anti‐inflammatory drugs, dual antihistamine/mast cell stabilizers, immunotherapy and corticosteroids. Topical, intranasal and systemic formulations of corticosteroids have traditionally provided the most effective relief of the inflammation and signs and symptoms associated with severe, acute exacerbations of SAC. However, steroid‐induced ocular and systemic side‐effects have limited the prescribing of these agents. This limitation of traditional corticosteroids led to the development of modified corticosteroids that retain the anti‐inflammatory mechanism of action of traditional corticosteroids with a much‐improved safety profile because of their rapid breakdown to inactive metabolites after exerting their activity. The development of one such novel corticosteroid, loteprednol etabonate (LE), led to the insertion of an ester (instead of a ketone) group at the carbon‐20 (C‐20) position of the basic corticosteroid structure. Clinical trials assessing this C‐20 ester corticosteroid have demonstrated similar efficacy to C‐20 ketone corticosteroids in the prevention or treatment of the signs and symptoms of SAC but with a greatly improved safety profile, as the C‐20 ester corticosteroid is less likely to elevate intraocular pressure. In addition, the ketone at the C‐20 position has been implicated in the formation of cataract, while nonketolic corticosteroids do not form Schiff base intermediates with lens proteins, which is a common first step in cataractogenesis. The clinical relevance of the C‐20 ester corticosteroid class, as modelled by LE, is that they provide both effective and safe treatment of the inflammation associated with SAC and relief of its signs and symptoms. Loteprednol etabonate offers a well‐tolerated treatment option for patients with debilitating acute exacerbations as well as chronic forms of the disease.

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A diverse array of microorganisms can colonize biomaterials implanted within the orbit and lacrimal drainage system. The authors' study showed that the majority of infected periocular and orbital alloplastic implants display biofilm when studied with electron microscopy (83%). The cultured organism type depended on the implant location and composition. Most infected silicone lacrimal stents grew atypical mycobacterium, whereas infected orbital fracture repair plates demonstrated yeast species. Biofilms are known to be antibiotic resistant, explaining the need to explant most infected alloplastic implants. Further research concerning treatment of biofilms may prevent explantation and improve surgical outcomes.

Recent findings about the pathophysiology of DED and ocular allergy have led to the greater understanding of the molecular and cellular mechanisms of ocular surface diseases leading to the potential novel targets for immunomodulation of anterior surface ocular disorders. New topical glucocorticoids, leukotriene receptor antagonists, IL-1 antagonists, IL-5, IL-4/IL-13 antagonists, integrin antagonists, and quinolone derivatives appear to be encouraging.