The rise of primary topical monotherapy with chemotherapeutic drugs and immunomodulatory agents represents an increasing recognition of the medical management of ocular surface squamous neoplasia (OSSN), which may replace surgery as the standard of care in the future. Currently, there is no consensus regarding the best way to manage OSSN with no existing guidelines to date. This paper seeks to evaluate evidence surrounding available treatment modalities and proposes an approach to management. The approach will guide ophthalmologists in selecting the most appropriate treatment regime based on patient and disease factors to minimize treatment related morbidity and improve OSSN control. Further work can be done to validate this algorithm and to develop formal guidelines to direct the management of OSSN.

Plastics are synthetic materials made from organic polymers that are ubiquitous in daily living and are especially important in the healthcare setting. However, recent advances have revealed the pervasive nature of microplastics, which are formed by degradation of existing plastic products. Although the impact on human health has yet to be fully characterised, there is increasing evidence that microplastics can trigger inflammatory damage, microbial dysbiosis, and oxidative stress in humans. Although there are limited studies investigating their effect on the ocular surface, studies of microplastics on other organs provide some insights. The prevalence of plastic waste has also triggered public outcry, culminating in the development of legislation aimed at reducing microplastics in commercial products. We present a review outlining the possible sources of microplastics leading to ocular exposure, and analyse the possible mechanisms of ocular surface damage. Finally, we examine the utility and consequences of current legislation surrounding microplastic regulation.

Climate change has contributed to changes in disease transmission. In particular, zoonoses such as tick-borne diseases are occurring in areas previously unsuitable for tick survival, with spread to non-endemic areas rising. Ophthalmic manifestations of tick-borne diseases are rare. Often overlooked, diagnosis requires awareness and a high level of suspicion, which may delay treatment. This review provides a comprehensive overview of ocular disease associated with ticks so that management protocols for patients can be designed and implemented. A narrative literature review was conducted. The current literature includes case series, case reports, and literature reviews. Ocular manifestations of tick-borne diseases include adnexal manifestations, conjunctivitis, keratitis, cranial nerve palsies, optic nerve disease, uveitis, exudative retinal detachment, and panophthalmitis, which may occur in isolation or as part of a systemic process. As there is no one constellation of ocular symptoms and signs diagnostic of tick-borne eye diseases, a systematic approach is recommended with particular attention to significant travel and exposure history. In this review, we identify significant risk factors and propose management strategies for afflicted patients to improve treatment outcomes while maintaining cost-effectiveness. Ophthalmologists and generalists will benefit from increased awareness of ocular manifestations of tick-borne diseases in the age of modern travel and climate change.

Ptosis is a common ocular complaint in the elderly population. While most cases are often due to involutional changes in the eyelid, neurogenic, mechanical or myogenic diseases should remain as important differential diagnoses. We report a case of a 75-year-old Chinese man who presented with chronic progressive ptosis and was initially managed as presumed seronegative ocular myasthenia gravis (MG). Despite positive bedside findings suggestive of MG, serological and electrophysiological investigations were inconclusive, and there was no clinical response to pyridostigmine. The diagnosis was achieved only after an opportunistic frontalis muscle biopsy obtained during planned brow lift surgery demonstrated histopathological features supportive of a mitochondrial aetiology. This case highlights the diagnostic challenge of distinguishing mitochondrial myopathies (MM) from ocular MG, emphasises clinical features that should prompt reconsideration of the diagnosis, and illustrates how opportunistic biopsy during oculoplastic surgery may facilitate diagnosis in selected patients with persistent diagnostic uncertainty.

Isotretinoin is a highly effective treatment for moderate-to-severe acne vulgaris but is associated with a broad spectrum of ophthalmic adverse effects. While dry eye disease secondary to meibomian gland dysfunction is the most common ocular complication, less familiar manifestations include nyctalopia, corneal abnormalities, retinal changes, idiopathic intracranial hypertension, and optic neuritis. Current evidence suggests that isotretinoin induces structural and functional changes in the meibomian glands, resulting in tear film instability and evaporative dry eye disease. Although many of these changes appear reversible following treatment cessation, some patients may experience persistent symptoms. This review was conducted as a structured narrative review of the ophthalmic adverse effects associated with systemic isotretinoin use. A literature search was performed using PubMed and Embase for articles published from inception to 1 June 2026. Nyctalopia is a well-established adverse effect attributable to rod photoreceptor dysfunction and may have important implications for occupations requiring optimal night vision. Corneal remodelling and ocular surface dysfunction are particularly relevant in contact lens wearers and patients considering refractive and corneal surgery, for instance corneal transplants. Rare but potentially sight-threatening neuro-ophthalmic complications have also been reported. Clinicians prescribing isotretinoin should routinely enquire about visual symptoms and maintain a low threshold for ophthalmic referral. Early recognition and collaborative management between dermatologists, general practitioners, and eye care practitioners are essential to minimise visual morbidity, promote ocular comfort and optimise patient outcomes. This review aimed to provide an updated, clinically focused synthesis of the ophthalmic adverse effects of isotretinoin, emphasising pathophysiological mechanisms, clinical presentation, evidence supporting reversibility, and practical recommendations for ophthalmologists, dermatologists, and primary care clinicians.