The aim of this study is to assess the effectiveness of a 12-week doxycycline treatment for thyroid eye disease (TED), an autoimmune condition associated with thyroid dysfunction. In this randomized controlled clinical trial, 82 patients were randomly assigned at a 1:1 ratio to receive doxycycline (50 mg) or to undergo no treatment. Various metrics, including margin reflex distance (MRD1 and MRD2), eyelid aperture, levator muscle function, lagophthalmos, proptosis, ocular motility, diplopia, and Graves’ ophthalmopathy-specific quality-of-life (GO-QOL) scale scoring were assessed. Exclusion criteria were uncontrolled systemic diseases, tetracycline allergies, pregnancy, lactation, or age below 18. The mean age was 51.6 years (SD), 87.8% of participants were female, and all were Caucasians. By week 12, the doxycycline group exhibited a significant improvement rate based on MRD2 (from 4 to 15 participants with physiological findings), clinical activity score (from 7 to 35 participants with non-active disease), and GO-QOL (from 51.22% to 70.73% of participants with a good life quality). Doxycycline showcased anti-inflammatory and immunomodulatory effects in treating TED, suggesting its potential efficacy for TED and other orbit inflammatory conditions. However, these results warrant further validation through future research involving extended follow-up periods and larger cohorts.

In this chapter, we intend to present the disease entity, which will include definition, types of exodeviation, symptoms, etiology, risk factors and nonsurgical treatment, as well as surgical management. The types of exodeviations that will be included are pseudoexotropia, exophoria, intermittent exotropia, sensory exotropia, and consecutive exotropia. We will also write about diagnosis of the disease itself, which includes the basics of a strabological examination. There will be special attention paid to the intermittent exotropia considering that intermittent exotropia is the most common type of exodeviations, with a special focus on its treatment. Postoperative treatment options will also be topic to discuss.

This pilot study evaluated the therapeutic effects of oral melatonin in patients diagnosed with primary Sjögren’s syndrome (pSS) and dry eye disease (DED). Twelve patients were treated with 5 mg of melatonin daily over an eight-week period. After treatment, significant improvements were recorded in Schirmer I test, tear break-up time (TBUT), and National Eye Institute (NEI) staining scores. Symptom severity decreased according to the Ocular Surface Disease Index (OSDI) and the EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI). Additionally, a significant reduction in serum interleukin-6 (IL-6) levels was observed, while C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) remained unchanged. Visual inspection of individual scores demonstrated a consistent trend of clinical improvement. No adverse effects were reported during the study period. These preliminary findings suggest that melatonin supplementation could represent a safe, adjunctive therapeutic strategy for managing autoimmune dry eye in pSS patients. Further large-scale clinical trials are warranted to confirm these results and explore the underlying mechanisms.

The reconstruction of complex orbitomaxillary defects requires biomaterials that can simultaneously provide structural stability, biocompatibility, and accurate restoration of facial volume and contour. While rigid polymers such as polyetheretherketone (PEEK) offer reliable mechanical support, they do not adequately replicate the viscoelastic behavior of soft tissues. This report presents a translational revision case employing a personalized hybrid biomaterial approach that combines a 3D-printed PEEK implant for structural orbital floor support with a patient-specific polydimethylsiloxane (PDMS) implant for malar volumetric augmentation. Reconstruction was planned using CT segmentation and contralateral mirroring. Patient-specific implants were subsequently designed using CAD/CAM techniques, combining a rigid PEEK implant for structural orbital support with a flexible PDMS implant for malar volumetric augmentation with complementary mechanical properties. Revision surgery included the removal of inadequately positioned titanium hardware, the release of incarcerated extraocular muscles, and the restoration of orbital anatomy and facial symmetry. Postoperative imaging demonstrated stable implant positioning and sustained orbitomaxillary stability. Despite successful anatomical reconstruction, residual functional sequelae, including strabismus related to the severity of the initial orbital trauma, persisted and were addressed separately in a staged manner, resulting in satisfactory ocular alignment and resolution of diplopia in primary gaze. This case underscores the complementary functional roles of rigid and elastic polymers and highlights the translational potential of PDMS as a permanent, patient-specific implant material for volumetric and contour restoration in craniofacial reconstruction.