Topical Azithromycin versus Oral Doxycycline for Meibomian Gland Dysfunction - A Systematic Review and Meta-Analysis

Presenter: Dr Dror Ben Ephraim Noyman

Meibomian gland dysfunction (MGD) is a common eye condition that progressively damages the ocular surface. This systematic review and meta-analysis evaluated seven randomized controlled trials involving 408 patients, comparing 1 month of topical azithromycin (1–1.5%, 1-4 times daily) versus 3-8 weeks of oral doxycycline (100-200 mg daily).

Both treatments significantly improved MGD signs and symptoms. However, topical azithromycin showed superior overall symptom relief (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.01–2.46) and greater reduction in tear debris (OR, 0.33; 95% CI, 0.15–0.74), while doxycycline was more effective for improving corneal staining (standardized mean difference [SMD], 0.64; 95% CI, 0.22–1.05). Azithromycin also improved tear breakup time (mean difference [MD], –1.28; 95% CI, –2.02 to –0.53) and caused fewer treatment-discontinuing adverse events (risk ratio [RR], 0.22; 95% CI, 0.08–0.63).

Overall, both therapies are effective, but topical azithromycin offers a better safety profile and may be preferred as a first-line treatment, especially for patients intolerant to systemic medications.

Efficacy and Safety of Topical Insulin in Patients with Dry Eye Disease: A Randomized Controlled Clinical Trial

Presenter: Dr Barbara Burgos Blasco

This randomized controlled trial evaluated the efficacy and safety of topical insulin eye drops (1 IU/mL) in patients with dry eye disease (DED) inadequately controlled by artificial tears. 

A total of 116 patients were randomized to receive insulin, cyclosporine 0.05%, or artificial tears for six months. Both insulin and cyclosporine significantly improved corneal staining compared with artificial tears, indicating better ocular surface healing; p = 0.024. The mean change from baseline in corneal staining was −1.05 ± 1.18 in the insulin group, −1.15 ± 1.27 in the cyclosporine group, and −0.31 ± 1.17 in the artificial tears group, indicating greater improvement with insulin and cyclosporine vs with artificial tears. No significant differences were observed in other clinical outcomes. 

Topical insulin was well tolerated, with no major safety concerns, suggesting it is a safe and effective alternative treatment for DED.

Topical Autologous Platelet-Rich Plasma versus Insulin Eye Drops in The Treatment of Neurotrophic Keratopathy

Presenter: Dr Dominika Wróbel-Dudzińska

This prospective study compared autologous platelet-rich plasma (PRP) eye drops and topical insulin eye drops in 90 patients with neurotrophic keratopathy and persistent corneal ulcers. 

Sixty patients received PRP and thirty received insulin, alongside standard supportive therapy. Both treatments significantly improved visual acuity as demonstrated by improvement in the mean best-corrected visual acuity (BCVA) from 0.14 ± 0.19 to 0.37 ± 0.31 in the PRP group and from 0.16 ± 0.18 to 0.44 ± 0.31 in the insulin group (p=0.001). An improvement in the subjective symptoms was noted in all patients; fluorescein staining decreased in 82% and conjunctival hyperemia in 93%. There was a significant increase in the corneal thickness at the thinnest point (p=0.01). Complete epithelial healing was achieved in 85% of PRP-treated patients and 90% of insulin-treated patients, with an average treatment duration of about five weeks. No adverse effects were reported. 

The findings indicate that both PRP and topical insulin are safe, effective, non-surgical options for promoting healing and restoring corneal health in neurotrophic keratopathy.

Effects of A Tear Substitute Containing Hyaluronic Acid 0.2% With or Without Hydrocortisone 0.001% on Sign/Symptoms of Dry Eye Disease and Tear Cortisol Levels: A Prospective, Randomized, Double-Masked, Controlled Clinical Trial

Presenter: Prof. Dr Giuseppe Giannaccare

This randomized, double-masked clinical trial compared hyaluronic acid (HA) 0.2% plus low-dose hydrocortisone (0.001%) with HA 0.2% alone in patients with mild-to-moderate dry eye disease (DED). 

Thirty-eight patients were evaluated over 45 days. The combination therapy significantly improved ocular symptoms, with ocular surface disease index (OSDI) scores decreasing from25 (19–31) to 12 (10–22); p=0.002, and increased tear film stability, with tear breakup time (TBUT) improving from 4 (4–6) to 7 (5–8) seconds at day 45 (p=0.036). 

Tear cortisol levels, a marker of ocular surface stress, decreased significantly from 1.9 (1.8–2.1) to 1.1 (0.7–1.7) and 1.1 (0.4–1.6) pg/µl, respectively at day 15 and 45; both p<0.001, whereas no changes occurred with HA alone. Cortisol reduction correlated with TBUT improvement (β=-1.25, p=0.046), suggesting enhanced ocular surface homeostasis.

The findings suggest that low-dose hydrocortisone enhances symptom relief and tear film stability in DED.

Efficacy of Oral Azathioprine in Refractory Severe Mixed Vernal Keratoconjunctivitis

Presenter: Dr Shivam Garg

This retrospective case series conducted at the Department of Ophthalmology, PGIMER, Chandigarh, India, evaluated oral azathioprine in five patients with severe mixed vernal keratoconjunctivitis (VKC) refractory to maximal topical therapy, including steroids, cyclosporine, and tacrolimus. 

Patients with persistent disease and steroid-induced glaucoma (mean age; 14.8 years) received oral azathioprine at 1-2 mg/kg/day. Complete clinical resolution of active disease was achieved in all patients within 3 months. Mean total follow-up was 18.5 months, with a post-azathioprine follow-up of 13.6 months, demonstrating sustained remission, stable intraocular pressure, and 0% relapse rate. Adverse events were limited to mild gastrointestinal discomfort in three patients, supporting azathioprine as a safe, effective, and steroid-sparing therapeutic option.

Oral azathioprine achieved effective disease control and sustained remission without relapses in severe, refractory mixed VKC. It represents an affordable, safe, and steroid-sparing systemic treatment option for patients unresponsive to maximal topical therapy, with minimal adverse effects.

Ocular Surface and Tear Film Changes Following Repeated Povidone-Iodine Exposure During Intravitreal Injections: A Prospective Cohort Study

Presenter: Dr Ivanka Maduna

This prospective observational case-control study from the Department of Ophthalmology, University Hospital Center Osijek evaluated short-term ocular surface effects of repeated povidone-iodine exposure in 30 patients receiving unilateral intravitreal anti-VEGF injections (47% male). 

Ocular surface parameters, including Schirmer test, tear film break-up time (TBUT), corneal fluorescein staining, conjunctival injection, and Ocular Surface Disease Index (OSDI), were assessed at baseline and days 1, 7, and 30. Treated eyes demonstrated significantly reduced TBUT on days 1 and 7 (P=0.04, P=0.02), increased OSDI scores (P<0.001, P=0.002), and greater corneal staining and conjunctival hyperemia (P<0.001). All changes resolved by day 30, indicating transient, reversible ocular surface disturbance.

Repeated povidone-iodine exposure causes transient ocular surface irritation, including dry eye symptoms, reduced TBUT, and mild corneal and conjunctival changes, which typically resolve within 1 month. Prophylactic ocular surface management may improve patient comfort during long-term anti-VEGF therapy.

Efficacy of Topical Insulin Eye Drops in Persistent Epithelial Defects: A Cost-Effectiveness Analysis in a Refractory Cohort

Presenter: Dr Lewis Larkman

This retrospective case series evaluated topical insulin (Humulin S 1 IU/mL inpolyethylene glycol/ propylene glycol and Hydroxypropyl guar, four times daily) in 9 patients with refractory persistent epithelial defects (PEDs). Mean age was 74.8±8.6 years, with a baseline PED area of 5.54±5.19 mm² and prior treatment failure for 40.11±23.77 days. Complete re-epithelialization was achieved in 7/9 patients (77.8%), with a mean healing time of 79.43±83.42 days. Successful cases demonstrated a mean visual acuity improvement of 0.40±0.47 LogMAR. Five patients required tarsorrhaphy and two amniotic membrane transplantation, while one achieved healing with insulin alone. Clinical visits were reduced by 1.89±1.97 per patient, supporting topical insulin as an effective, resource-efficient adjunct for complex PED management.

Topical insulin eye drops achieved high epithelial healing rates in refractory PEDs, including complex cases requiring or failing surgical interventions. They also reduced follow-up visits, highlighting a cost-effective and resource-efficient role in managing difficult-to-heal corneal defects.

Ocular Nocardiosis Mistaken for Fungal Corneal Ulcer

Presenter: Dr Sharah Rahman Rahman

This case report from a tertiary ophthalmic center describes a 47-year-old female farmer with Nocardia keratitis following agricultural trauma, initially misdiagnosed as fungal keratitis. After 1 month of unsuccessful treatment with topical natamycin, clotrimazole, and oral ketoconazole, vision deteriorated to hand movements. Slit-lamp examination revealed a dry feathery stromal ulcer with a 2 mm hypopyon. Corneal scrapings showed a negative KOH mount, while Gram stain demonstrated thin, beaded, branching Gram-positive filaments consistent with Nocardia species. Therapy was switched to topical amikacin 2%, tobramycin ointment, and oral moxifloxacin, resulting in marked improvement within 1 week. Complete healing occurred by 1 month, with best-corrected visual acuity improving to 6/18 and minimal residual scarring.

Nocardia keratitis can closely mimic fungal keratitis; prompt Gram stain-based diagnosis enables targeted antibiotic therapy, preventing treatment delays and optimizing visual outcomes.

Low-Concentration Povidone-Iodine (≤1%) in Ophthalmology: Antimicrobial Efficacy and Ocular Surface Safety

Presenter: Dr Wojciech Luboń

Povidone-iodine (PVP-I) is a key ophthalmic antiseptic used for perioperative infection prevention. While standard 5-10% solutions are highly effective, they may cause temporary corneal epithelial damage, tear film instability, and ocular discomfort. A systematic narrative review of clinical, ex vivo, and in vitro studies assessed low-concentration PVP-I (≤1%) for antimicrobial efficacy and ocular safety. 

Findings showed that 0.25-1% PVP-I effectively reduced conjunctival bacterial flora and demonstrated antiviral activity comparable to standard formulations. Low-concentration solutions exhibited less epithelial toxicity, greater cell viability, and better tolerability. Formulations around 0.6-0.66% may offer an optimal balance of efficacy and safety, though further prospective studies are needed.

Clinical Outcomes of a Multicenter Study Following the Use of Losartan for Corneal Fibrosis in A Low-Income Country

Presenter: Dr Ruddy Aarón Ortiz Lopez

This multicenter real-world study in Guatemala evaluated topical losartan (0.8 mg/mL, six times daily) for treating corneal fibrosis (leukoma) in 96 eyes across 10 ophthalmology centers. Patients received treatment for at least 3 months, with outcomes including visual acuity, quality of life, corneal imaging, and topographic parameters.

Topical losartan significantly improved visual outcomes, with uncorrected visual acuity improving from 1.02 ± 0.60 to 0.71 ± 0.57 logMAR and best-corrected visual acuity from 0.65 ± 0.63 to 0.39 ± 0.53 logMAR (both p<0.01). Refractive status also improved, with spherical equivalent decreasing from 3.05 ± 3.11 D to 1.89 ± 1.60 D (p<0.05). Corneal parameters showed marked remodeling, including reductions in corneal densitometry (0.39 ± 0.07 to 0.15 ± 0.03) and normalization of Q-value (-0.21 ± 0.04 to -0.01 ± 0.03) (both p<0.05). Maximum epithelial thickness increased from 67.9 ± 13.6 μm to 89.3 ± 16.5 μm (p<0.05). Quality of life also improved significantly. No treatment-related adverse events were reported. These findings suggest that topical losartan is a safe, affordable, and effective non-surgical option for managing corneal fibrosis, particularly in resource-limited settings with restricted access to corneal transplantation.

Eyelash Extensions and Demodex Folliculorum: Influence on Eyelid Microenvironment and Ocular Surface Health

Presenter: A/Prof. Tetiana Zhmud

This study evaluated the prevalence of Demodex folliculorum in individuals undergoing eyelash extension procedures and its potential impact on ocular surface health. Among 345 surveyed participants aged 16 to 28 years, 24.9% had experience with eyelash extensions. Frequent eyelash extension use was associated with ocular surface changes, with meibography showing meibomian gland dysfunction (MGD) in 85% of girls who had undergone the procedure more than 10 times. In a subgroup of 25 regular eyelash-extension users, microscopic analysis of eyelashes (4 lashes collected from each eyelid) was performed to detect Demodex folliculorum. 96% (24/25) of participants tested positive for Demodex folliculorum. Clinical signs of demodicosis were observed in 18 participants and included itching, eyelid margin irritation, hyperemia, edema, eyelash sticking, scales, and cylindrical dandruff. Nearly half (47.6%) reported post-procedure symptoms such as discomfort, redness, tearing, or itching.

The findings suggest that repeated eyelash extension procedures may create conditions that favor Demodex proliferation, potentially through altered lid hygiene and changes in the eyelid microenvironment. The authors recommend routine eyelid hygiene counseling and preventive eye examinations for individuals undergoing regular eyelash extension procedures.

Dry Eye Disease in Healed Keratitis: A Paired Eye Comparative Study Ocular surface disease

Presenter: Chandradevi Shanmugam 

This prospective observational study conducted at AIIMS, New Delhi, evaluated long-term ocular surface alterations in 50 patients with unilateral healed keratitis by comparing affected eyes with contralateral fellow eyes. Comprehensive assessments included OSDI, Schirmer test, tear film breakup time (TBUT), meibography, ocular surface analyzer, LipiView interferometry, and NEI staining scores.

The mean patient age was 39.7 years, and 61.2% of patients exhibited abnormal OSDI scores, indicating persistent ocular surface symptoms. Compared with fellow eyes, healed eyes demonstrated significantly poorer visual acuity (logMAR 1.84 vs 0.14; p<0.001), lower Schirmer test values (14.1 vs 16.8 mm; p=0.028), and reduced TBUT (8.17 vs 9.91 s; p=0.030). Meibomian gland dropout was significantly greater in healed eyes (p<0.001). Ocular surface damage was also more pronounced, with higher NEI corneal staining scores (10.96 vs 5.67), conjunctival staining scores (7.02 vs 4.89), and total staining scores (17.94 vs 10.73) (all p<0.001). Lipid layer thickness measurements obtained using OSA and LipiView also differed significantly (p=0.057).

These findings indicate that healed keratitis is associated with persistent tear film instability, meibomian gland dysfunction, and epithelial damage, supporting the need for continued ocular surface monitoring and dry eye management even after clinical resolution

Semaglutide Alleviates Age-Related Dry Eye Disease by Restoring Lacrimal Gland Structure and Function

Presenter: Xin Zuo

This preclinical study investigated the effects of semaglutide on age-related dry eye disease (DED) using a naturally aged mouse model. Long-term semaglutide treatment improved tear secretion preserved lacrimal gland (LG) architecture, and alleviated ocular surface damage. Single-cell RNA sequencing revealed that aging was associated with acinar cell loss, expansion of fibroblast and immune cell populations, and activation of inflammatory and stress-related pathways, all of which were attenuated by semaglutide. 

Additionally, semaglutide reduced senescent cell accumulation across epithelial, stromal, and immune compartments, while decreasing oxidative stress in acinar cells, suppressing pro-fibrotic signaling in fibroblasts, and attenuating inflammatory and chemotactic activation in macrophages, indicating broad modulation of key pathogenic pathways.

These findings suggest that semaglutide mitigates age-related LG dysfunction and DED by targeting cellular senescence and associated pathological processes.

ESCRS 2026, 11^th-15^th September, London, UK.