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Dry eye disease (DED) is a multifactorial disorder of the ocular surface, characterised by tear film instability, hyperosmolarity, inflammation, and neurosensory abnormalities. Its clinical heterogeneity and the weak correlation between symptoms and signs complicate both diagnosis and management. Conventional assessments, such as patient-reported symptom questionnaires and basic clinical tests like the Schirmer test, are useful; however, their variability and limited sensitivity highlight the need for more reliable and objective diagnostic tools. This narrative review summarises and analyses current imaging approaches used for the diagnosis of DED. A comprehensive literature search was performed in the PubMed and Google Scholar databases to identify relevant studies published up to October 2025. In recent years, imaging technologies have revolutionised the approach to DED. Modalities such as in vivo confocal microscopy (IVCM), meibography, anterior segment optical coherence tomography (AS-OCT), interferometry, thermography, tear fluorescein clearance, impression cytology, and multifunctional imaging systems allow for non-invasive, high-resolution, and reproducible assessment of ocular surface structures and tear film dynamics. The integration of these techniques into clinical practice supports a more personalised management of DED. Future directions include further technological refinements and the application of artificial intelligence (AI) to imaging analysis, with the potential to enhance diagnostic precision and facilitate earlier intervention. While imaging cannot replace a thorough clinical examination, it has become an essential adjunct that significantly enriches the evaluation and management of patients with DED.

In order to test the hypothesis that in primary open angle glaucoma (POAG), an important cause of irreversible blindness, a spreading of neurodegeneration occurs through the brain, we performed multimodal MRI and subsequent whole-brain explorative voxelwise analyses in 13 advanced POAG patients and 12 age-matched normal controls (NC). Altered integrity (decreased fractional anisotropy or increased diffusivities) of white matter (WM) tracts was found not only along the visual pathway of POAG but also in nonvisual WM tracts (superior longitudinal fascicle, anterior thalamic radiation, corticospinal tract, middle cerebellar peduncle). POAG patients also showed brain atrophy in both visual cortex and other distant grey matter (GM) regions (frontoparietal cortex, hippocampi and cerebellar cortex), decreased functional connectivity (FC) in visual, working memory and dorsal attention networks and increased FC in visual and executive networks. In POAG, abnormalities in structure and FC within and outside visual system correlated with visual field parameters in the poorer performing eyes, thus emphasizing their clinical relevance. Altogether, this represents evidence that a vision disorder such as POAG can be considered a widespread neurodegenerative condition.

To evaluate the prevalence of ptosis, strabismus and the combination of both after glaucoma surgery and determine which kind of surgery is most likely to be linked to these complications. A total of 705 clinical records of patients who underwent glaucoma surgery at the University Eye Clinic of IRCCS Ospedale Policlinico San Martino, Genoa, from January 1, 2010, to December 31, 2020, were retrospectively evaluated. Surgery procedures were divided in three groups: \"Ab interno\", \"Ab externo\" and \"Muscle isolation\". Out of all patients 26 developed ptosis alone (3.7%), two developed bilateral ptosis, with a mean of 2.2 ± 1.08 procedures per patient. Highest incidence of ptosis was noticed in patients who underwent muscle isolation surgery (5.7%). Twelve patients developed strabismus alone (1,7%), four underwent unilateral surgery and eight bilateral surgery, with an average of 3.3 ± 1.78 procedures per patient. Strabismus was more frequent following extraocular muscle manipulation surgery (7.5%), showing a statistically significant difference (OR: 6.57; 95% CI: 1.71-21.65; p = 0.003) Seven patients developed both strabismus and ptosis (1.0%), one patient with bilateral ptosis. Four underwent bilateral surgery and three underwent unilateral surgery. The mean number of surgeries was 2.9 ± 1.07, showing a statistically significant difference compared to the uncomplicated glaucoma group (OR: 1.58; 95% CI: 1.01-2.25; p = 0.02). The prevalence of both ptosis and strabismus was higher after muscle isolation surgery (1.9%). Ptosis, strabismus and the combination of both are rare complications after glaucoma surgery, mostly linked to surgery with muscle isolation.

Glaucoma is a progressive, chronic optic neuropathy characterized by a typical visual field defects. Four main classes of topical medication are actually available on the market: beta-blockers, prostaglandins, alpha2-agonists, and topical carbonic anhydrase inhibitor to treat intraocular pressure (IOP). The aim of this review is to outline the efficacy of timolol and to evaluate the impact of this treatment on patients’ quality of life. Among beta-blockers, timolol is most used at three different concentrations: 0.1%, 0.25%, and 0.5%. While the first one is a gel, the other two products are solution. Timolol has few topical side effects, while it has some important systemic side effects on the cardiac and respiratory systems. The balance between efficacy and safety is always the main aspect to care patients. Because of the less efficacy of timolol 0.1% solution, the possibility to use carbomers as vehicle in the gel drops helped timolol 0.1 to be used in clinics, extending the time contact between the active ingredient and the surface of the cornea. Using preservative-free timolol 0.1 for treatment, IOP was at the same level of the other beta-blockers at higher concentration, but it was better tolerated. Preservative-free treatment improved the quality of life reducing dry-eye like symptoms; furthermore, the presence of an artificial tear in the medication bottle could help adherence. The once daily dosing improves compliance.

ObjectiveElevated intraocular pressure (IOP) is a major risk factor for glaucoma and the primary target of current therapies. When IOP-lowering drugs are insufficient, surgical intervention may be required; however, conjunctival and subconjunctival scarring often limits long-term success. Although intraoperative and postoperative antimetabolite treatments help preserve surgical outcomes, they are associated with ocular side effects. This study investigated the effects of selected anticancer drugs on the proliferation of human Tenon’s fibroblasts (HTFs), key mediators of postoperative scarring.Methods and analysisPrimary HTFs were isolated from explants obtained during glaucoma surgery and characterised by immunofluorescence. The cytotoxic effects of candidate drugs were assessed using the MTT and LDH assays, while HTF migration and proliferation were evaluated by wound-healing assays. Additional cytotoxicity testing was performed on primary human trabecular meshwork cells (HTMCs) to assess ocular safety.ResultsUnder the experimental conditions used, HTF proliferation, rather than migration, was the main driver of wound closure. Among the drugs tested, pemigatinib and sorafenib significantly slowed wound closure. Pemigatinib showed no cytotoxicity in either HTFs or HTMCs, whereas sorafenib induced a moderate (28%) cytotoxic effect in HTMCs.ConclusionsPemigatinib and sorafenib, two Food and Drug Administration-approved anticancer agents, effectively reduced HTF proliferation, with pemigatinib showing a more favourable safety profile. These findings identify selective fibroblast growth factor receptor (FGFR) inhibition as a promising strategy for modulating postoperative fibrosis and support further preclinical studies to evaluate the safety and efficacy of FGFR inhibitors as potential adjuncts in glaucoma surgery.

PurposeOptical Coherence Tomography (OCT) is a powerful instrument for helping clinicians detect and monitor glaucoma. The aim of this study was to provide a detailed mapping of the relationships between visual field (VF) sensitivities and measures of retinal structure provided by a commercial Spectral Domain (SD)-OCT system (RTvue-100 Optovue).MethodsSixty-three eyes of open angle glaucoma patients (17 males, 16 females, and mean age 71 ± 7.5 years) were included in this retrospective, observational clinical study. Thickness values for superior and inferior retina, as well as average values, were recorded for the full retina, the outer retina, the ganglion cell complex, and the peripapillary retinal nerve fiber layer (RNFL). RNFL thickness was further evaluated along eight separate sectors (temporal lower, temporal upper, superior temporal, superior nasal, nasal upper, nasal lower, inferior nasal, and inferior temporal). Point-wise correlations were then computed between each of these OCT measures and the visual sensitivities at all VF locations assessed via Humphrey 10-2 and 24-2 perimetry. Lastly, OCT data were fit to VF data to predict glaucoma stage.ResultsThe relationship between retinal thickness and visual sensitivities reflects the known topography of the retina. Spatial correlation patterns between visual sensitivities and RNFL thickness along different sectors broadly agree with previously hypothesized structure–function maps, yet suggest that structure–function maps still require more precise characterizations. Given these relationships, we find that OCT data can predict glaucoma stage.ConclusionGanglion cell complex and RNFL thickness measurements are highlighted as the most promising candidate metrics for glaucoma detection and monitoring.

Brinzolamide is a white powder commercially formulated as a 1% ophthalmic suspension to reduce intraocular pressure (IOP). Pharmacologically, brinzolamide is a highly specific, non-competitive, reversible, and effective inhibitor of carbonic anhydrase II (CA-II), able to suppress formation of aqueous humor in the eye and thus to decrease IOP. Several clinical trials have evaluated its safety and the most commonly ocular adverse events are blurred vision (3%-8%), ocular discomfort (1.8%-5.9%), and eye pain (0.7%-4.0%). Brinzolamide has been introduced to treat ocular hypertension and primary open-angle glaucoma. In some clinical studies it has been estimated that brinzolamide reduced IOP by was about 18%. Brinzolamide can be added to beta-blockers and prostaglandins. In the latter combination, because prostaglandin derivatives improve the uveoscleral outflow but also increase the activity of CA in ciliary epithelium with a secondary increase in aqueous humor secretion, and slightly reduce the efficacy of prostaglandin analogues, theoretically topical CA inhibitors (CAI) decrease IOP by inhibiting CA-II, thus improving prostaglandin efficacy as well as lowering IOP. Brinzolamide could have a secondary possible effect on ocular flow too. Some clinical studies showed a mild improvement of ocular blood flow. Theoretically, CAI could give rise to metabolic acidosis, with secondary vasodilatation and improvement of blood flow. Systemic acidosis can occur in the setting of oral CAI therapy, and local acidosis within ocular tissues is theoretically possible with topical CAI therapy, with the potential for a local increase in ocular blood flow. In conclusion, topical CAI treatment has efficacy in IOP-lowering ranging from 15% to 20%. From published data, brinzolamide can be used as first-line medication, even if other medications have a higher efficacy, with few side effects and it is a good adjunctive treatment. In some type of glaucoma patients with a vascular dysregulation, topical CAI could have a double effect: reducing IOP and improving ocular blood flow.

ObjectivesTo compare motor skills in patients with infantile strabismus and age and sex-matched control subjects aged 5–11 years.MethodsMotor performances were assessed by the Italian version of Developmental Coordination Disorder Questionnaire 2007 (DCDQ) in children with infantile strabismus and age and sex-matched control subjects. Patients affected by specific neurological, cognitive and behavioural disorders were excluded from the study.ResultsThere were 43 patients included in the study, 23 in the strabismus group (14 males, 9 females, mean age 7.5 ± 2.0 years) and 24 in the control group (14 males and 10 females, mean age 7.2 ± 1.7 years. The overall DCDQ score was significantly lower in children with strabismus compared with control subjects (58.7 ± 11.3 vs. 74.2 ± 1.5; P < 0.001). Children with strabismus and no stereopsis showed a lower DCDQ score compared with those with normal stereopsis (50.8 ± 9.5 vs. 67.3 ± 4.8; P < 0.001).ConclusionMotor skills are reduced in children with strabismus compared with control subjects. Strabismus and lack of binocular vision are factors potentially contributing to developmental coordination disorder.

To evaluate frequency, conversion rate, and risk factors for blindness in glaucoma patients treated in European Universities. This multicenter retrospective study included 2402 consecutive patients with glaucoma in at least one eye. Medical charts were inspected and patients were divided into those blind and the remainder ('controls'). Blindness was defined as visual acuity≤0.05 and/or visual field loss to less than 10°. Unilateral and bilateral blindness were respectively 11.0% and 1.6% at the beginning, and 15.5% and 3.6% at the end of the observation period (7.5±5.5 years, range:1-25 years); conversion to blindness (at least unilateral) was 1.1%/year. 134 eyes (97 patients) developed blindness by POAG during the study. At the first access to study centre, they had mean deviation (MD) of -17.1±8.3 dB and treated intraocular pressure (IOP) of 17.1±6.6 mmHg. During follow-up the IOP decreased by 14% in these eyes but MD deteriorated by 1.1±3.5 dB/year, which was 5-fold higher than controls (0.2±1.6 dB/year). In a multivariate model, the best predictors for blindness by glaucoma were initial MD (p<0.001), initial IOP (p<0.001), older age at the beginning of follow-up (p<0.001), whereas final IOP was found to be protective (p<0.05). In this series of patients, blindness occurred in about 20%. Blindness by glaucoma had 2 characteristics: late diagnosis and/or late referral, and progression of the disease despite in most cases IOP was within the range of normality and target IOP was achieved; it could be predicted by high initial MD, high initial IOP, and old age.

ObjectiveTo compare the two surgical techniques in terms of efficacy, safety, and postoperative management over 36 months of follow-up.MethodsThis retrospective clinical cohort study compared the outcome of trabeculectomy surgery and Xen gel implant in patients having uncontrolled glaucoma. Patients were recruited using the following inclusion criteria: uncontrolled intraocular pressure (IOP) on maximally tolerated medical therapy, healthy conjunctiva freely mobile in the superior sector, open-angle, glaucomatous visual field damage, full follow upfollow-up of at least 36 months. Thirty-four patients were submitted to trabeculectomy and 34 to Xen gel implant. We set the lower limit at 6mmHg mm Hg and the upper limit ≤12 mm Hg for criteria A, upper limit to ≤15 mm Hg for criteria B and upper limit ≤18 mm Hg for criteria C. Criteria for success have been characterizedcharacterised according to whether or not this has been achieved without (complete success) or with IOP -lowering medications (qualified success).ResultsFor all survival curves, trabeculectomy was superior to Xen gel implant. When considering complete success, the log-rank test for criteria A was statistically significant (pp=0.006), marginally significant for criteria B (pp=0.065) and not significant for criteria C (pp=0.23). When qualified success was considered, trabeculectomy was superior to Xen gel for criteria A, B, and C (pp=0.012, pp=0.033 and pp=0.025, respectively). Higher number of post-operative flat chamber and bleb leakage was observed in the trabeculectomy group.ConclusionXen gel implant techniques offer a better safety profile but a lower IOP reduction compared to compared with the gold -standard technique.