Dry eye disease (DED) is a highly prevalent, chronic and progressive condition that affects 5–33% of the world’s adult population

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.

The present clinical case concerns two patients with mycotic keratitis because of Candida parapsilosis in which corneal confocal microscopy presented a characteristic feature of this pathogen. Both described patients used a therapeutic contact lens and administered a therapy with steroid eye drops which are well known predisposing factors for the onset of corneal mycoses. This report can be useful for correctly identifying the pathologic condition and quickly directing the therapy.

Purpose: To evaluate aqueous humor concentrations of nepafenac following topical administration of 0.3% and 0.1% formulations, to assess the influence of timing of instillation on intraocular exposure. Methods: Aqueous humor samples collected during anterior segment surgery were analyzed. Nepafenac concentrations were quantified in 151 samples (0.3% instilled once daily: n = 73; 0.1% instilled three times daily: n = 78). Amfenac was quantified only in the nepafenac 0.3% group (n = 73), owing to the stepwise validation of the analytical method (see Limitations). Due to right-skewed distributions, concentrations were summarized as median (IQR) and geometric mean with 95% confidence intervals Mann–Whitney U test and Spearman’s rank correlation coefficient were applied. Postoperative optical coherence tomography was performed at 1, 2, and 3 months to assess the occurrence of Irvine–Gass syndrome. Results: Geometric mean nepafenac concentrations were 22.13 nM (95% CI 15.85–30.91) for 0.3% and 21.73 nM (95% CI 13.29–35.53) for 0.1% (p = 0.319). Within the 0.1% group, instillation timing significantly influenced concentrations (p < 0.001), with markedly higher levels approximately 30–60 min after instillation compared with the 10–12 h subgroup. Amfenac correlated with nepafenac (ρ = 0.56, p < 0.001). No cases of clinically evident Irvine–Gass syndrome were observed. Conclusion: No cases of clinically evident Irvine–Gass syndrome were observed; however, the study was not powered or designed to assess clinical efficacy. Timing of instillation is a major determinant of aqueous humor nepafenac concentrations. Preoperative instillation shortly before surgery may optimize intraoperative drug availability and support maintenance of mydriasis. Standardized sampling is essential for robust pharmacokinetic comparisons.