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Background : The aim of this work is to evaluate efficacy and safety of corneal collagen cross linking as adjunctive therapy for treating infectious keratitis. Methods: This is a randomized prospective controled clinical trial. Seventy eight (78) eyes with clinically suspected infectious keratitis were enrolled in this study. The range of age of the enrolled patients was more than or equal to18 years. They were randomly classified into two groups each of 39 eyes, Group A(control group): received topical appropriate conventional broad spectrum antimicrobial therapy alone based on sensitivity reports and Group B: received combined topical appropriate conventional broad spectrum antimicrobial therapy based on sensitivity reports and corneal collagen cross linking for infectious keratitis (PACK-CXL). Identification of organisms was done by lab study before treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT ( AS-OCT). Written informed consent was obtained from all participants and the study was approved by the research ethical committee of Faculty of Medicine, Zagazig and Cairo University. The work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving humans. Results: Complete healing and resolution (Successful treatment) was observed in 76.9 % of eyes and 97.4 % of patients in groups (A & B), respectively. They showed a statistically highly significant difference (P <0.001). Mean resolution period was 10.87±3.28 and 7.02±2 weeks in group (A & B), respectively, with statistically significant difference (P = 0.002) between both groups, being shorter in group (B).Only 2.6% of our cases had resistance to treatment in CXL compared to group A, who had 23.1% of resistance. There was no statistically significant difference between both groups as regards complications of treatment. Conclusions: PACK-CXL is a promising , non-invasive and available treatment option. It has a synergistic effect with antimicrobial treatment that gives a good outcome results in treatment of infectious keratitis. Also, it avoids the antibiotics resistance that has become rapidly spreading worldwide.

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Purpose To describe a simple and minimally invasive technique using double-frequency YAG laser for correction of mild medial lower eyelid ectropion with punctal eversion and assess the efficacy of the technique by measuring the tear film meniscus pre- and post-laser treatment using imageJ software. Methods This study included 23 eyes of 19 patients with lower eyelid ectropion with punctal eversion. All patients were treated by double-frequency YAG laser applied to lower medial conjunctiva. Tear film thickness was assessed using imageJ software pre- and post-argon laser treatment. Results There was a highly significant change detected after argon laser treatment as regarding the mean of the height of tear film which was found to be significantly lower after argon laser treatment compared to before it (81.1 pixels versus 193.1 pixels, respectively) (P < 0.001). Conclusion Double-frequency YAG laser applied to lower medial palpebral conjunctiva is a simple, easy, safe, and effective procedure which can be used as a solo treatment in early cases of punctal eversion with no or mild medial canthal tendon laxity.