Conjunctivitis is a frequent disease of the eye with the typical clinical sign being the "red eye" and comprises a very heterogeneous group with different causes. In general, infectious conjunctivitis must be strictly differentiated from non-infectious conjunctivitis. Allergic conjunctivitis is a subtype of non-infectious conjunctivitis and imposes as an acute, intermittent or chronic, inflammation which is most frequently caused by airborne allergens. The leading clinical sign is chemosis, and patients typically complain about itching. Allergic conjunctivitis is often a reaction to topical and systemic drugs or cosmetics as well as animal hairs from cats and/or dogs. Allergic conjunctivitis is sub-classified into the following forms: seasonal allergic conjunctivitis (also termed: hay fever conjunctivitis), atopic conjunctivitis, vernal conjunctivitis, upper limbal (kerato-) conjunctivitis, and conjunctivitis associated with various oculomucocutaneous syndromes. In each form, there are distinctive features in: clinical appearance, generating agent(s), as well as treatment as listed here.

Viruses account for 80% of all cases of acute conjunctivitis and adenovirus; enterovirus and herpes virus are the common causative agents. In general, viral conjunctivitis spreads easily. Therefore, to control the spread, it is crucial to quickly diagnose illnesses, strictly implement hand washing laws, and sanitize surfaces. Swelling of the lid margin and ciliary injection are subjective symptoms, and eye discharge is frequently serofibrinous. Preauricular lymph node swelling can occasionally occur. Approximately 80% of cases of viral conjunctivitis are caused by adenoviruses. Adenoviral conjunctivitis may become a big global concern and may cause a pandemic. Diagnosis of herpes simplex viral conjunctivitis is crucial for using corticosteroid eye solution as a treatment for adenovirus conjunctivitis. Although specific treatments are not always accessible, early diagnosis of viral conjunctivitis may help to alleviate short-term symptoms and avoid long-term consequences.

Bacterial conjunctivitis is common and occurs in patients of all ages. Typical signs are a red eye and purulent drainage that persists throughout the day. Gonococcal and chlamydial conjunctivitis must be treated with systemic antibiotics. Bacterial conjunctivitis due to most other organisms can be treated empirically with topical antibiotics. Red flags suggesting a complicated case requiring referral to an ophthalmologist include reduced vision, severe eye pain, a hazy-appearing cornea, contact lens use, and poor response to empirical treatment.

Background: Blepharitis is an ocular surface disease and chronic ophthalmic condition. This paper reports on the development of psychometric evaluation of a patient-reported measure of blepharitis symptoms.

Methods: Self-reports of 13 blepharitis symptoms collected in a Phase 3 multi-site, randomized, double-masked, 4-arm parallel group, clinical trial of 907 individuals with blepharitis (mean age = 62, range: 19-93; 57% female) were analyzed. Symptoms asked about were: eyes that itch; eyes that burn; eyelids feel heavy or puffy; feel like something is in your eye; dry eyes; gritty eyes; irritated eyes; eyes that tear or water; crusty eyes; flaking from your eyelids; eyelids that are stuck together; red eyes or eyelids; and debris like pieces of skin or dandruff in your eyes.

Results: Categorical factor analyses provided support for two multi-item symptom scales: Irritation (9 items, alpha = 0.88) and Debris (4 items, alpha = 0.85). Spearman-rank order correlations of the Irritation and Debris scales with the Ocular Surface Disease total score were 0.63 and 0.41, respectively (p's < 0.001). Rank-order correlations between ratings of clinicians and self-reports of puffy eyes (r = 0.07, p < .05), red eyes (r = 0.12, p < .001), debris (r = 0.03, p > 0.05), and irritation (r = 0.47, p < .001).

Conclusions: This study provides support for the psychometric properties and construct validity of the Irritation and Debris scales for assessing symptoms of blepharitis. The associations between the self-reports and clinician ratings of 4 symptoms indicate substantial unique information in the new self-reported symptom items.

Trial Registration: The trial was registered at ClinicalTrials.gov under the registry number NCT01408082 .

Contact dermatitis is a common inflammatory skin condition characterized by erythematous and pruritic skin lesions that occur after contact with a foreign substance. There are two forms of contact dermatitis: irritant and allergic. Irritant contact dermatitis is caused by the non-immune-modulated irritation of the skin by a substance, leading to skin changes. Allergic contact dermatitis is a delayed hypersensitivity reaction in which a foreign substance comes into contact with the skin; skin changes occur after reexposure to the substance. The most common substances that cause contact dermatitis include poison ivy, nickel, and fragrances. Contact dermatitis usually leads to erythema and scaling with visible borders. Itching and discomfort may also occur. Acute cases may involve a dramatic flare with erythema, vesicles, and bullae; chronic cases may involve lichen with cracks and fissures. When a possible causative substance is known, the first step in confirming the diagnosis is determining whether the problem resolves with avoidance of the substance. Localized acute allergic contact dermatitis lesions are successfully treated with mid- or high-potency topical steroids, such as triamcinolone 0.1% or clobetasol 0.05%. If allergic contact dermatitis involves an extensive area of skin (greater than 20 percent), systemic steroid therapy is often required and offers relief within 12 to 24 hours. In patients with severe rhus dermatitis, oral prednisone should be tapered over two to three weeks because rapid discontinuation of steroids can cause rebound dermatitis. If treatment fails and the diagnosis or specific allergen remains unknown, patch testing should be performed.

Term,Definition
Acute rhinosinusitis,"Up to 4 wk of purulent nasal drainage (anterior, posterior, or both) accompanied by nasal obstruction, facial pain/pressure/fullness,a or both:"
,"
• Purulent nasal discharge is cloudy or colored, in contrast to the clear secretions that typically accompany viral upper respiratory infection, and it may be reported by the patient or observed on physical examination."
,"
• Nasal obstruction may be reported by the patient as nasal obstruction, congestion, blockage, or stuffiness, or it may be diagnosed by physical examination."
,"
• Facial pain/pressure/fullness may involve the anterior face or periorbital region, or it may manifest with headache that is localized or diffuse."
Viral rhinosinusitis,"Acute rhinosinusitis that is caused by, or is presumed to be caused by, viral infection. A clinician should diagnose viral rhinosinusitis when"
,
• symptoms or signs of acute rhinosinusitis are present <10 d and the symptoms are not worsening.
Acute bacterial rhinosinusitis,"Acute rhinosinusitis that is caused by, or is presumed to be caused by, bacterial infection. A clinician should diagnose acute bacterial rhinosinusitis when"
,a. symptoms or signs of acute rhinosinusitis fail to improve within 10 d or more beyond the onset of upper respiratory symptoms
,or
,b. symptoms or signs of acute rhinosinusitis worsen within 10 d after an initial improvement (double worsening).

Orbital cellulitis (OC) is an inflammatory process that involves the tissues located posterior to the orbital septum within the bony orbit, but the term generally is used to describe infectious inflammation. It manifests with erythema and edema of the eyelids, vision loss, fever, headache, proptosis, chemosis, and diplopia. OC usually originates from sinus infection, infection of the eyelids or face, and even hematogenous spread from distant locations. OC is an uncommon condition that can affect all age groups but is more frequent in the pediatric population. Morbidity and mortality associated with the condition have declined with advances in diagnostic and therapeutic options; however, OC can still lead to serious sight- and life-threatening complications in the modern antibiotics era. Therefore, prompt diagnosis and treatment remain crucial. Antibiotic coverage, computed tomography imaging, and surgical intervention when needed have benefitted patients and changed the disease prognosis. We review the worldwide characteristics of OC, predisposing factors, current evaluation strategies, and management of the disease.

Thyroid eye disease (TED) is a rare disease that can lead to decreased quality of life, permanent disfigurement, and vision loss. Clinically, TED presents with exophthalmos, periorbital edema, extraocular muscle dysfunction, and eyelid retraction, and can lead to vision-threatening complications such as exposure to keratopathy and dysthyroid optic neuropathy (DON). Over the last several years, significant advancements have been made in the understanding of its pathophysiology as well as optimal management. Ethnic variations in the prevalence, clinical presentation, and risk of vision-threatening complications of TED are summarized, and risk factors associated with TED are discussed. Additionally, significant advances have been made in the management of TED. The management of TED traditionally included anti-inflammatory medications, orbital radiation therapy, orbital surgical decompression, and biologic therapies. Most recently, targeted therapies such as teprotumumab, an insulin-like growth factor-1 receptor antagonist, have been studied in the context of TED, with promising initial data. In this review, updates in the understanding and management of TED are presented with a focus on the international variations in presentation and management.

The swollen red eyelid is a common presentation in primary care. An understanding of the anatomy of the orbital region can guide care. Factors that guide diagnosis and urgency of care include acute vs. subacute onset of symptoms, presence or absence of pain, identifiable mass within the eyelid vs. diffuse lid swelling, and identification of vision change or ophthalmoplegia. Superficial skin processes presenting with swollen red eyelid include vesicles of herpes zoster ophthalmicus; erythematous irritation of contact dermatitis; raised, dry plaques of atopic dermatitis; and skin changes of malignancies, such as basal or squamous cell carcinoma. A well-defined mass at the lid margin is often a hordeolum or stye. A mass within the midportion of the lid is commonly a chalazion. Preseptal and orbital cellulitis are important to identify, treat, and differentiate from each other. Orbital cellulitis is more often marked by changes in ability of extraocular movements and vision as opposed to preseptal cellulitis where these characteristics are classically normal. Less commonly, autoimmune processes of the orbit or ocular tumors with mass effect can create an initial impression of a swollen eyelid.

Dry eye is a common yet complex condition. Intrinsic and extrinsic factors can cause dysfunction of the lids, lacrimal glands, meibomian glands, ocular surface cells, or neural network. These problems would ultimately be expressed at the tear film-ocular surface interface. The manifestations of these problems are experienced as symptoms such as grittiness, discomfort, burning sensation, hyperemia, and secondary epiphora in some cases. Accurate investigation of dry eye is crucial to correct management of the condition. Techniques can be classed according to their investigation of tear production, tear stability, and surface damage (including histological tests). The application, validity, reliability, compatibility, protocols, and indications for these are important. The use of a diagnostic algorithm may lead to more accurate diagnosis and management. The lack of correlation between signs and symptoms seems to favor tear film osmolarity, an objective biomarker, as the best current clue to correct diagnosis.

Background: Preseptal and orbital cellulitis are two types of infection surrounding the orbital septum with very different potential outcomes. Our aim was to describe key differential features of both conditions, laying special emphasis on diagnostic and therapeutic tools.

Methods: A retrospective review of patients admitted to a tertiary hospital over a 15-year period (January 2004-October 2019) was conducted. We included 198 patients with preseptal and 45 with orbital cellulitis. Descriptive statistics were performed to examine the available information.

Results: Statistically significant differences were found between patients with preseptal and orbital cellulitis regarding age (3.9 ± 2.14 vs. 7.5 ± 4.24 years), presence of fever (51.5% vs. 82.2%), and preexisting sinusitis (2% vs. 77.8%) (all P < 0.001). Diplopia, ophthalmoplegia and proptosis were only present in orbital cellulitis (P < 0.001). Median values of C-reactive protein were significantly higher among children with orbital involvement [136.35 mg/L (IQR 74.08-168.98) vs. 17.85 (IQR 6.33-50.10), P < 0.0001]. A CRP>120 mg/L cut-off point for orbital cellulitis was obtained. Early CT scans were performed in 75.6% of suspected orbital cellulitis and helped detecting complications at an early stage. Abscesses were revealed in 70.6% of cases, especially medial subperiosteal abscesses (58.8%). All patients received intravenous antibiotics, whereas corticosteroids were preferred in patients with orbital implication (8.6% vs. 73.3%, P < 0.001). Only 26.7% of patients required additional surgery.

Conclusions: Clinical presentation and CRP are extremely sensitive for differential diagnosis of preseptal and orbital cellulitis. Prompt initiation of intravenous antibiotics is mandatory and can prevent surgical procedures even in cases with incipient abscesses.

If the anterior chamber angle is obstructed suddenly, the IOP can rise rapidly to high levels. The characteristic clinical signs and symptoms include pressure-induced corneal edema (experienced as blurred vision and occasionally as halos around lights), a mid-dilated pupil, lens opacities (glaucomflecken), vascular congestion (i.e., conjunctival and episcleral), eye pain, headache, and nausea/vomiting. This condition is considered an AACC and may be self-limited or may recur. Untreated, this entity may cause permanent vision loss or blindness. The fellow eye is also at high risk of AACC.

NIAID criteria (2006),WAO criteria (2020)
"Anaphylaxis is highly likely when any one of the following 3 criteria are fulfilled: 1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (eg, generalized hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of the following: a. Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia) b. Reduced BP or associated symptoms of end-organ dysfunction (eg, hypotonia [collapse], syncope, incontinence) 2. Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours): a. Involvement of the skin mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula) b. Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia) c. Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence) d. Persistent gastrointestinal symptoms (eg, crampy abdominal pain, vomiting) 3. Reduced blood pressure after exposure to known allergen for that patient (minutes to several hours): a. Infants and children: low systolic BP (age specific) or greater than 30% decrease in systolic BP b. Adults: systolic BP of less than 90 mm Hg or greater than 30% decrease from that person's baseline","Anaphylaxis is highly likely when any one of the following 2 criteria are fulfilled: 1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (eg, generalized hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of the following: a. Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia) b. Reduced BP or associated symptoms of end-organ dysfunction (eg, hypotonia [collapse], syncope, incontinence) c. Severe gastrointestinal symptoms (eg, severe crampy abdominal pain, repetitive vomiting), especially after exposure to non-food allergens 2. Acute onset of hypotension or bronchospasma or laryngeal involvement after exposure to a known or highly probable allergen for that patient (minutes to several hours), even in the absence of typical skin involvement. a. Excluding lower respiratory symptoms triggered by common inhalant allergens or food allergens perceived to cause “inhalational” reaction in the absence of ingestion."