Purpose: To report a rare case of bilateral conjunctival and epibulbar extranodal Rosai-Dorfman disease (RDD) without lymph node involvement, potentially associated with long-term use of benzalkonium chloride (BAK)-containing glaucoma medications. Case Presentation: A 68-year-old male with a 10-year history of primary open-angle glaucoma, managed with multiple topical hypotensive agents, developed bilateral conjunctival and epibulbar nodules following chronic recurrent episodes of conjunctival inflammation over those 10 years. Histopathological examination and immunohistochemical staining confirmed the diagnosis of RDD, characterized by histiocytic proliferation with prominent emperipolesis. The patient underwent surgical excision of the lesions with homoconjunctival grafting. Postoperatively, his glaucoma regimen was modified to a preservative-free (BAK-free) topical therapy, and selective laser trabeculoplasty was performed to reduce the need for additional topical therapy. Comprehensive systemic evaluation revealed no lymphadenopathy or other extranodal organ involvement. At one-year follow-up, there was no evidence of recurrence, conjunctival inflammation had markedly subsided, and the glaucoma remained stable. Conclusions: This case highlights a potential association between chronic conjunctival inflammation induced by BAK-containing glaucoma medications and the de novo emergence of epibulbar RDD. Although RDD remains a rare and poorly understood histiocytic disorder, our findings suggest that sustained ocular surface inflammation may act as a trigger in its pathogenesis. To our knowledge, this is the first reported case of ocular RDD potentially linked to long-term exposure to topical hypotensive therapy. Further studies are warranted to investigate the role of chronic inflammatory stimuli in the development of extranodal RDD, particularly within ocular tissues.

Objectives: This study aimed to investigate the association between optical coherence tomography angiography (OCTA) parameters and cardiovascular (CV) risk scores in individuals with type 1 diabetes (T1D). Methods: A cross-sectional analysis of a large-scale prospective OCTA trial cohort (ClinicalTrials.gov NCT03422965) was performed. Demographic, systemic, and ocular data—including OCTA imaging—were collected. T1D participants were stratified into three CV risk categories: moderate (MR), high (HR), and very high risk (VHR). Individualized predictions for fatal and non-fatal CV events at 5 and 10 years were calculated using the STENO T1 Risk Engine calculator. Results: A total of 501 individuals (1 eye/patient; 397 T1D, 104 controls) were included. Subjects with MR (n = 37), HR (n = 152) and VHR (n = 208) exhibited significantly reduced vessel density (VD) (20.9 ± 1.3 vs. 20.2 ± 1.6 vs. 19.3 ± 1.8 mm⁻¹, p < 0.05), perfusion density (PD) (0.37 ± 0.02 vs. 0.36 ± 0.02 vs. 0.35 ± 0.02%, p < 0.05) and foveal avascular zone circularity (0.69 ± 0.06 vs. 0.65 ± 0.07 vs. 0.63 ± 0.09, p < 0.05). Statistically significant negative correlations were observed between CV risk and OCTA parameters including VD, PD, and retinal nerve fiber layer thickness, while central macular thickness (CMT) showed a positive correlation (p < 0.05). Notably, CMT was significantly associated with 5-year CV risk. Conclusions: OCTA-derived metrics, particularly reduced retinal VD and PD, are associated with elevated CV risk scores in T1D patients. These findings suggest that OCTA may serve as a valuable non-invasive tool for identifying individuals with increased CV risk scores.