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Conjunctivitis caused by viruses, bacteria, or allergies is one of the most common eye conditions in primary care. There is no single sign or symptom that accurately differentiates viral from bacterial conjunctivitis. A comprehensive history and physical examination can guide diagnosis. Viral and allergic conjunctivitis are more common in adults and typically present with watery discharge. Supportive care options for viral conjunctivitis include artificial tears, cold compresses, and antihistamine eye drops. Strict personal hygiene, including frequent handwashing, is essential to decrease the risk of transmission. Topical antihistamines with mast cell–stabilizing activity are the treatment of choice for allergic conjunctivitis. Bacterial conjunctivitis is more common in children and typically presents as mucopurulent discharge with the eyelids matted shut. Delayed antibiotic prescribing has been found to have similar symptom control as immediate prescribing. Ophthalmology referral is indicated for conjunctivitis in a neonate or patients with severe pain, decreased vision, recent ocular surgery, vesicular rash on the eyelids or nose, history of rheumatologic disease, or immunocompromised state. Illustration by Alex Webber

Background Conjunctivitis is a known comorbidity of atopic dermatitis. Dupilumab clinical trials for moderate-to-severe atopic dermatitis in adults showed a higher conjunctivitis incidence for dupilumab-treated patients than placebo-treated patients, whereas trials for uncontrolled asthma reported lower rates for both dupilumab and placebo. Objective The objective of this study was to evaluate the incidence and severity of conjunctivitis in dupilumab clinical trials in adolescents with moderate-to-severe atopic dermatitis or uncontrolled asthma. Methods We evaluated the incidence of conjunctivitis in adolescents (aged 12 to < 18 years) in three phase III trials. Ocular events were diagnosed and treated based on patient-reported symptoms and an external eye examination by study investigators, in most cases without an ophthalmologic referral. In LIBERTY AD ADOL (16-week, randomized, placebo-controlled, double-blinded trial), adolescents with moderate-to-severe atopic dermatitis were randomized to subcutaneous placebo, dupilumab 300 mg every 4 weeks, or dupilumab every 2 weeks (200 mg, patients < 60 kg at baseline; 300 mg, ≥ 60 kg at baseline). In LIBERTY AD PED-OLE (open-label extension), pediatric patients from previous dupilumab atopic dermatitis trials received dupilumab 2 mg/kg or 4 mg/kg weekly (up to 300 mg) or 300 mg every 4 weeks. In LIBERTY ASTHMA QUEST (randomized, double-blinded, placebo-controlled trial), patients with uncontrolled moderate-to-severe asthma were randomized to 52 weeks of add-on therapy with dupilumab 200 or 300 mg every 2 weeks or matched-volume placebo. Results In ADOL, more dupilumab-treated (17/165; 10.3%) than placebo-treated patients (4/85; 4.7%) reported one or more conjunctivitis event. All events were mild to moderate in severity; 12 (7.3%) dupilumab-treated and 4 (4.7%) placebo-treated patients received treatment. Most patients with conjunctivitis (dupilumab, 12/17; placebo, 4/4) recovered/resolved during the treatment period. The risk of conjunctivitis showed no relationship with dupilumab serum concentration. In PED-OLE, 12/275 adolescents (4.4%) reported one or more conjunctivitis event. Most conjunctivitis events were mild to moderate. Ten patients received treatment for conjunctivitis. Ten patients recovered/resolved during the study. In QUEST, similar low proportions of dupilumab-treated (2/68, 2.9%) and placebo-treated (1/39, 2.6%) adolescents reported one or more conjunctivitis event. All events were mild to moderate. One dupilumab-treated patient received treatment for conjunctivitis. All cases recovered/resolved during the study. No patients in these trials discontinued study treatment temporarily or permanently because of conjunctivitis. In ADOL, one case of unspecified viral keratitis (specific viral etiology not known) in the dupilumab 300-mg every 4 weeks group and one case of allergic blepharitis in the placebo group were reported; both events resolved during the treatment period, and neither led to treatment discontinuation. Conclusions Dupilumab-treated adolescents in atopic dermatitis trials had a higher incidence of conjunctivitis than placebo-treated patients, whereas overall rates of conjunctivitis among adolescents in the asthma trial were lower than in atopic dermatitis trials and were similar for dupilumab- and placebo-treated patients. Most events were mild to moderate, most recovered/resolved, and none prompted study withdrawal. These results are similar to those reported in adult trials and support a drug–disease interaction. ClinicalTrials.gov Identifiers NCT03054428, NCT02612454, NCT02414854. FSZJ5YMfe98kiNB8ymgqFL Conjunctivitis in Dupilumab Clinical Trials for Adolescents with Atopic Dermatitis or Asthma (MP4 18453 kb)

From March through October 2024, a total of 46 human cases of highly pathogenic avian influenza A(H5N1) virus infections were identified in the United States, with 20 linked to poultry exposure and 25 to dairy cow exposure.

We previously reported that 16.9% of allergic conjunctival disease cases were local allergic conjunctivitis (LAC). We therefore retrospectively investigated the pathological and clinical changes of LAC. Tear, conjunctival, and blood tests were performed on 313 patients with allergic conjunctival disease. A total of 313 patients with allergic conjunctival disease were surveyed using tear, conjunctival, and blood tests and QOL Questionnaire. In addition, we retrospectively examined the clinical test results of patients who agreed to re-examination more than one year after being diagnosed with LAC. Of the 313 cases, 44 were diagnosed as LAC (age ranged in 11–85 years (mean 67.8 years)) and 269 were diagnosed as non-LAC (7–92 years (mean 58.2 years)). There were 6 males (13.6%) and 38 females (86.4%), with more females even after age adjustment ( p  = 0.043). A QOL survey showed that LAC was characterized by less interference with daily life than non-LAC. After re-examination, 6 of 12 patients (50.0%) remained with LAC, while the remaining half changed to non-LAC. LAC was more common in older women than non-LAC. Considering the clinical change from LAC to non-LAC, it is speculated that the pathology of LAC may change over time.

Background Sterile granuloma/pyogranuloma syndrome (SGPS) is an immune-mediated disease producing nodular and plaque-like skin lesions in dogs. Ocular involvement has been reported mainly in periocular skin and eyelids, with no histologically documented conjunctival lesions. This report describes a palpebral conjunctival nodule in a dog with SGPS and its distinction from nodular ocular surface diseases such as nodular granulomatous episcleritis and other differential diagnoses. Case presentation A 3-year-10-month-old Polish Tatra Dog presented with mucopurulent discharge, hyperaemia of the bulbar, palpebral, and third-eyelid conjunctivae, a firm 1 cm nodule on the right lower palpebral conjunctiva, and medial eyelid thickening with ectropion. Three months earlier, multiple cutaneous nodules had been diagnosed as SGPS. Topical and systemic corticosteroid therapy improved the skin lesions but neither the conjunctival mass nor the eyelid thickening, necessitating surgical excision of the nodule. In contrast, the eyelid thickening resolved during a subsequent prednisone taper, and no recurrence was observed over 20 months. Histopathology revealed a well-demarcated conjunctival stromal nodule with deep extension into the palpebral stroma, surrounding blood vessels, peripheral nerves, and the orbicularis oculi muscle. The infiltrate consisted of CD3⁺ T cells, CD20⁺/CD79⁺ B cells, plasma cells, MAC387-positive macrophages, and scattered Iba1-positive histiocytes, with small neutrophilic foci and no epithelioid cells, multinucleated giant cells, mitotic figures, or foreign material. Conclusion This case represents the first histopathologically confirmed conjunctival manifestation of SGPS. Its conjunctival origin and mixed lymphocytic–histiocytic profile expand the recognized spectrum of SGPS and support including SGPS in the differential diagnosis for well-circumscribed conjunctival nodules. Surgical excision may be required when such lesions do not regress or cause mechanical dysfunction.

Purpose The high prevalence of allergic conjunctivitis in Japan necessitates novel, easy-to-use treatment options for prophylactic use. We evaluated the safety and efficacy of a newly-developed 0.5% epinastine topical eyelid cream to prevent the development of allergic conjunctivitis. Study design This was a phase 3, single-centre, double-masked, intra-patient randomised trial in asymptomatic adults (aged 20–65 years) with seasonal allergic conjunctivitis in Japan. Methods The left and right eyes of eligible patients were randomised to receive a topical application of either 0.5% epinastine cream (~ 30 mg per dose) to one eye or placebo cream to the other (on the outer skin of the upper and lower eyelids) after a conjunctival antigen challenge (CAC) test. Symptom severity was assessed up to 24 h post-treatment. Primary efficacy endpoints were mean ocular itching and conjunctival hyperaemia severity scores in each eye; safety endpoints included adverse events (AEs) and adverse drug reaction (ADRs). Results In total, 30 patients (60 eyes) were included in the study. The 0.5% epinastine topical eyelid cream reduced mean ocular itching scores (difference in least squares means ± standard error, − 1.12 ± 0.214; p <  0.0001) and mean conjunctival hyperaemia scores (− 0.54 ± 0.197; p  = 0.0097) 24 h after treatment versus placebo. The 0.5% epinastine topical eyelid cream was well tolerated, with no AEs or ADRs reported. Conclusion With its novel route of administration, 0.5% epinastine topical eyelid cream may be considered a unique, easy-to-use, once-daily treatment option to prevent the onset of seasonal allergic conjunctivitis.

[This corrects the article DOI: 10.1371/journal.pone.0231966.].[This corrects the article DOI: 10.1371/journal.pone.0231966.].