Multicenter randomized, double-masked, placebo-controlled trial, N=165 (86 drug, 79 placebo), all on a low-sodium weight-reduction diet. Improvement in perimetric mean deviation was 1.43 dB versus 0.71 dB with placebo; the 0.71 dB difference has a 95% CI that reaches zero (0 to 1.43 dB, P=.050). Papilledema grade (treatment effect -0.70, 95% CI -0.99 to -0.41, P<.001) and NEI VFQ-25 vision-related quality of life (treatment effect 6.35, 95% CI 2.22 to 10.47, P=.003) improved more clearly. The authors call the visual field benefit modest and state that its clinical importance remains to be determined.

Masked, placebo-controlled crossover trial in 12 patients treated in 2-week periods: 10 of 12 had both subjective and objective visual acuity improvement, 6 of 12 had less angiographic leakage, and 500 mg/day was more effective than 250 mg/day. A 2022 systematic review and meta-analysis (32 studies reviewed, 7 pooled) concluded that oral and topical carbonic anhydrase inhibitors and local steroids do reduce central macular thickness in this setting, but rated the overall quality of evidence poor because of inferior study designs and small patient numbers.

Weak and uncontrolled. A single case report of recurrent filamentary keratitis refractory to lubricants, punctal plugs, steroids, and lid hygiene showed complete filament resolution and symptom relief sustained at 10 months on a compounded 10% solution given with preservative-free ointment and oral doxycycline, and a systematic review of 106 ocular studies found 5% to 10% four times daily the most common regimen with rare corneal necrosis at higher concentrations.

Very weak. Two case reports used topical 5% inside a multimodal regimen of topical corticosteroid, lid hygiene, and low-level light therapy, and the authors state the contribution of the light therapy cannot be determined from these findings alone, and the acetylcysteine contribution is likewise unisolated.

Herpetic Eye Disease Study Acyclovir Prevention Trial, a randomized double-masked placebo-controlled multicenter trial in 703 immunocompetent patients who had had ocular HSV disease within the preceding year: cumulative probability of a recurrence of any type of ocular HSV disease over the 12-month treatment period was 19% on acyclovir versus 32% on placebo (P<0.001), and among the 337 patients with a history of stromal keratitis, recurrent stromal keratitis was 14% versus 28% (P=0.005); nonocular, primarily orofacial, recurrence was also lower at 19% versus 36% (P<0.001), and there was no rebound in the rate of HSV disease in the 6 months after treatment stopped. A further analysis of the same trial gave rate ratios of 0.62 (95% CI 0.39 to 0.97) for preventing epithelial keratitis and 0.57 (95% CI 0.36 to 0.89) for preventing stromal keratitis, with the absolute benefit greatest in patients with the most prior episodes, and the authors report that the benefit in preventing stromal keratitis was seen solely among patients with a history of stromal keratitis.

Randomized double-blind trial in 60 patients with simple dendritic corneal ulceration comparing acyclovir 400 mg tablets 5 times daily against acyclovir ophthalmic ointment 5 times daily: 88.9% healed on the oral drug versus 96.6% on the ointment, a difference that was not significant, with a median healing time of 5 days in both groups and trough tear concentrations within or above the range of mean in vitro ID50 levels for HSV-1. A Cochrane review of 137 studies in 8333 eyes reports that in a limited number of studies oral acyclovir alone (RR 0.92, 95% CI 0.79 to 1.07) or combined with a topical antiviral (RR 1.36, 95% CI 0.68 to 2.74) appeared as effective as a single topical antiviral agent.

Herpetic Eye Disease Study, a randomized double-masked placebo-controlled multicenter trial in 104 patients with HSV stromal keratitis without accompanying epithelial keratitis, all of whom also received topical prednisolone phosphate and trifluridine: median time to treatment failure was 84 days (95% CI 69 to 93) on acyclovir versus 62 days (95% CI 57 to 90) on placebo, and by 16 weeks 75% versus 74% had failed, neither difference significant. The authors concluded there was no statistically or clinically significant beneficial effect on time to treatment failure, proportion failing, proportion resolving, time to resolution, or 6-month best-corrected visual acuity, while also reporting that visual acuity improved over 6 months in more patients on acyclovir than on placebo.

Randomized observer-masked single-center trial (N=180, 60 per arm): mean total ocular symptom score fell from 7.7 at baseline to 0.2 at day 14 with alcaftadine, versus 0.4 with olopatadine 0.2% and 0.1 with bepotastine 1.5% (day 14 ANOVA P=0.0008); absolute separation between the three actives was small. Contact lens wearers and severe allergic conjunctivitis were excluded.

A narrative review of pediatric preseptal and orbital cellulitis lists amoxicillin among the antibacterials often used, notes significant variation in agent selection, supports transition from IV to oral therapy once clinical and laboratory improvement is clear, and reports total durations trending toward about 2 weeks. It offers practice pattern and antimicrobial stewardship guidance, not comparative efficacy data. Coverage is the practical limit: the label confines the skin and skin structure indication to beta-lactamase negative Streptococcus spp., Staphylococcus spp., and E. coli, so beta-lactamase producing staphylococci fall outside it.

Single-center retrospective chart review of 137 patients with acute or chronic dacryocystitis, 205 samples and 156 isolates: S. aureus was the most common at 46 of 156 (30%), then Pseudomonas species 19 of 156 (12%) and Propionibacterium acnes 15 of 156 (10%). On in vitro susceptibility the two most effective oral antibiotics in this population were levofloxacin and amoxicillin/clavulanate, but the latter would still have met at least one resistant organism in 32% of patients and potentially another 8% (levofloxacin 16% and 15%). The authors conclude that routine treatment with any single antibiotic may fail in up to a third of patients and recommend culturing at the time empiric therapy is started. Susceptibility data only, no clinical outcome and no dosing data.

A narrative review of pediatric preseptal and orbital cellulitis lists amoxicillin-clavulanate among the antibacterials often used, notes significant variation in agent selection, supports transition from IV to oral therapy once clinical and laboratory improvement is clear, and reports total durations trending toward about 2 weeks. That is expert review, not comparative trial evidence. The nearest treatment data are postseptal, not preseptal: in a retrospective series of 48 children with subperiosteal orbital abscess complicating acute ethmoiditis, oral amoxicillin-clavulanate was the step-down for about 8.5 days after a mean of four days of IV third-generation cephalosporin plus metronidazole, given to 94% of the children, and all were cured without sequelae. The practical argument for this product over plain amoxicillin is spectrum, since the label lists S. aureus, H. influenzae and M. catarrhalis among covered organisms.

This is the test that displaced cocaine. Denervation makes the dilator's alpha-1 receptors supersensitive, so apraclonidine dilates the affected pupil while very weakly constricting the normal one, and the anisocoria REVERSES. Across 31 eyes with oculosympathetic paresis and 54 control eyes, all confirmed against the cocaine test, apraclonidine dilated the affected pupils by a mean 2.04 mm and constricted the controls by 0.14 mm, reversed the anisocoria in every Horner case, and lifted the ptotic lid by a mean 1.75 mm. The authors concluded it has at least the sensitivity and specificity of the cocaine test. Two cautions the study does not cover: supersensitivity takes days to weeks to develop, so an acute Horner can test falsely negative, and apraclonidine is avoided in infants for the risk of central nervous system depression.

A retrospective cohort of 145 patients starting azathioprine as their only non-corticosteroid agent found 62% gained sustained complete inactivity of inflammation within a year and 47% got prednisone down to 10 mg a day or less while holding control. It suited intermediate uveitis best, where 90% reached sustained inactivity within a year. The two cautions are that it is slow, needing several months to reach its goal, and that roughly a quarter of patients hit a treatment-limiting side effect within the year, though these were typically reversible.

Randomized 22-center trial in perennial allergic conjunctivitis (N=139) against masked placebo, with an open-label levocabastine arm: itching and conjunctival redness both improved versus placebo (P<0.001), the combined score improving 1.9 (SD 1.1) versus 0.6 (SD 1.1) on placebo at day 7 from a baseline of 3.7 to 3.8 on a 0 to 6 scale, and continuing to improve through day 42. Bitter taste and application site reaction were the most frequent adverse events. The US indication covers itching only, not redness.

Blepharitis appears only in this label's Dosage and Administration section; Indications and Usage is limited to conjunctiva and cornea, so lid-margin use sits outside the stated indication. No product-specific trial exists. A Cochrane systematic review and meta-analysis of 34 trials in 2,169 participants with chronic blepharitis found topical antibiotics as a class gave some symptomatic relief and eradicated lid margin bacteria in anterior blepharitis, but its overall conclusion was that there is no strong evidence that any treatment cures chronic blepharitis; that finding is class-level and was not measured on this product.

Single center open label comparative trial in 50 patients with vernal keratoconjunctivitis, aged 5 to 15, allocated to 1.5% solution or olopatadine 0.1% BID for 8 weeks. The authors report quicker relief of watering, ocular discomfort, and conjunctival hyperemia in the bepotastine arm but state the difference was not statistically significant; olopatadine improved papillary hypertrophy faster, and the two were equal for itching.

No randomized trial. Retrospective multicenter safety surveillance across 10 US centers (142 patients treated with this drug, 85 with moxifloxacin 0.5% for perspective) reported a single adverse event, mild superficial punctate keratitis, with similar treatment outcomes between groups; regimens varied and many patients received additional topical antibacterials, and the authors state a prospective trial is needed to isolate the drug's contribution.

The CATT trial randomised patients with neovascular AMD to bevacizumab or ranibizumab, monthly or as-needed. At two years bevacizumab and ranibizumab produced equivalent effects on visual acuity when given on the same schedule, and as-needed dosing produced less gain than monthly dosing for both drugs.

Protocol T compared aflibercept, bevacizumab and ranibizumab for centre-involved diabetic macular oedema. At one year all three improved vision; aflibercept was more effective than bevacizumab where baseline acuity was 20/50 or worse, and the three were comparable where baseline acuity was better than that.

Weak, case-series level. Retrospective single-center chart review of 7 children (4 X-linked retinoschisis, 2 retinitis pigmentosa, 1 Leber congenital amaurosis), all prescribed TID, 6 treated: 4 of 6 showed a mild decrease in central macular thickness and all 6 had improved acuity at a mean 33 months, and the authors state that further study is needed. The larger carbonic anhydrase inhibitor evidence base in this setting was built on topical dorzolamide and oral acetazolamide, not on brinzolamide.

Phase 4 randomized double-masked trial, 96 patients on BID fixed combination plus prostaglandin analog versus 92 on vehicle plus prostaglandin analog for 6 weeks: least squares mean diurnal IOP change -5.59 mmHg (95% CI -6.2 to -5.0) versus -2.15 mmHg (95% CI -2.7 to -1.6), treatment difference -3.44 mmHg (95% CI -4.2 to -2.7, P below 0.001). Ocular adverse events 21.1% versus 8.7%; the trial did not compare BID against the labeled TID regimen.

The phase 2 randomized, double-masked, vehicle-controlled dose-ranging trial (81 TID, 82 BID, 84 vehicle, including Sjogren dry eye) missed its primary endpoint: change in Schirmer I at week 4 did not differ from vehicle (TID difference 0.93 mm, 95% CI -1.47 to 3.32, P=0.078; BID 2.31 mm, 95% CI -0.08 to 4.70, P=0.066, 1-sided alpha 0.025). Symptom scores (SANDE) fell significantly with TID only, and the authors conclude that larger studies are warranted.

Read the route before the result. A randomised trial compared intravitreal clindamycin with dexamethasone against classic therapy, which in that trial was 6 weeks of pyrimethamine and sulfadiazine plus prednisolone and contained no clindamycin. Across 68 patients the primary endpoint did not separate the arms: lesions reduced 57.0% against 58.4% (p=0.569), so the finding is that the injection is an acceptable alternative rather than a better one, and 34 patients per arm cannot exclude a real difference either way. Nothing here tests the oral capsule this card describes.

Cocaine blocks noradrenaline reuptake at the iris dilator, so a pupil with any oculosympathetic lesion dilates less than its fellow and the anisocoria widens. Tested in 119 patients with Horner syndrome against 50 normal subjects, the odds of Horner syndrome rose with the size of the post-cocaine anisocoria: at 0.8 mm the odds ratio was about 1050 to 1, with a lower 95% confidence limit of 37 to 1. The authors also found that simply measuring the anisocoria AFTER cocaine predicted better than calculating the change from baseline. It confirms the diagnosis and says nothing about where the lesion sits.

Cochrane review of 30 randomized trials and 4344 participants concluded that topical antihistamines and mast cell stabilizers as a class, sodium cromoglycate among the drugs evaluated, reduce symptoms and signs of seasonal allergic conjunctivitis versus placebo in the short term, with no long term efficacy data and highly variable reporting quality. A comparative review of the seasonal trials notes that cromoglycate eye drops did not control breakthrough symptoms during peak pollen challenge.

No trial in preseptal cellulitis was found on PubMed. The IDSA skin and soft tissue infection guideline names this the oral agent of choice for methicillin-susceptible strains in adults and states it is inactive against MRSA; the dose shown is that guideline's recommendation for staphylococcal skin and soft tissue infection generally, not a preseptal cellulitis regimen, and it is higher than the label's own severe-infection dose of 250 mg every 6 hours. Coverage is the practical limit: in a 10-year retrospective review of 90 ocular MRSA isolates from 75 patients at one Hong Kong center, preseptal cellulitis was the most common community-associated MRSA presentation, and MRSA accounted for a mean 12.9% of ocular S. aureus infections per year at that center.

Retrospective interventional case series of 25 patients (35 eyes) treated with difluprednate as the single agent. 83% of eyes reached clinical resolution, at a median of 6 weeks. Eyes started at 4 or more times daily were more likely to resolve (hazard ratio 3.43, 95% CI 1.19 to 9.88, P=0.02). 9 eyes developed IOP elevation (defined as 24 mmHg or higher), 4 eyes lost 2 or more lines of BCVA with 1 of those from cataract progression, and 1 eye needed cataract surgery. Uncontrolled and retrospective; the authors conclude only that it may effectively treat non-infectious anterior scleritis with a tolerable side effect profile.

Meta-analysis of 11 nonrandomized clinical reports (194 patients, 358 eyes, of which 243 eyes received a topical carbonic anhydrase inhibitor) pooled oral and topical treatment and found central macular thickness fell 46.02 microns (95% CI 31.08 to 60.96), while the effect on visual acuity was inconsistent across studies. The authors state the anatomic benefit rests on nonrandomized data and call for randomized trials.

Retrospective interventional case series of 10 genetically confirmed patients (18 eyes) followed a mean 8.4 years: mean central subfield thickness went from 429.88 to 372.28 microns (P = 0.10, not significant) while mean logMAR acuity improved from 0.45 to 0.34 (P below 0.01). No randomized data exist, and paradoxical worsening of macular cysts on topical therapy has been reported in a single case.

A randomized trial in 150 patients with chronic meibomian gland dysfunction refractory to lid hygiene compared 20 mg twice daily, 200 mg twice daily and placebo: both active arms beat placebo on tear break-up time, Schirmer score and symptom counts at 1 month with no significant difference between the two doses, while side effects were more frequent on the high dose (39.13% versus 17.39%, P=0.002). A 2021 Cochrane review of oral antibiotics for chronic blepharitis pooled this and one other trial (220 participants total) and graded the evidence very low certainty for both symptoms and clinical signs.

A randomized trial of 39 patients with moderate to severe papulopustular rosacea compared this regimen against low-dose oral isotretinoin: ocular symptoms and meibomian gland dysfunction grading improved more in the doxycycline arm (P<0.05), while the other measured parameters, best corrected acuity, Schirmer, break-up time and rose bengal staining, did not reach statistical significance.

A retrospective single-observer case series of 21 patients reported 15 of 21 (71%) symptom free at 8 weeks, with 15 of 18 (83%) and 11 of 15 (73%) denying relapse at 6 and 12 months. An earlier retrospective interventional series of 7 eyes used 50 mg twice daily for 2 months plus a topical corticosteroid and saw pain resolve and epithelial defects heal within 2 to 10 days, with no recurrence over a mean 21.9 months. No randomized trial exists for this indication.

Randomized, open-label, multicenter trial during allergy season (N=146, 75 treated vs 71 on rewetting drops alone): mean comfortable wearing time rose 1.33 h vs 0.43 h (P=0.012) and total wearing time 0.35 h vs -0.32 h (P=0.008), with greater improvement in itch and overall comfort and fewer rewetting drop instillations. Read alongside the label, which states the product is not for contact lens-related irritation and that lenses come out before instillation.

VICI randomised 114 patients with treatment-naive chronic CSCR of 4 months or more to eplerenone or placebo for up to 12 months. Mean best-corrected visual acuity at 12 months was 80.4 letters on eplerenone against 79.5 on placebo, a difference of 1.73 letters (95% CI -1.12 to 4.57, p=0.24). The authors concluded that ophthalmologists who currently prescribe eplerenone for chronic CSCR should discontinue this practice. Hyperkalaemia occurred in 8 patients (14%) in each group.

SPECTRA randomised 107 patients to half-dose PDT or oral eplerenone in an open-label trial, eplerenone given for 12 weeks. At 3 months, subretinal fluid had resolved completely in 78% of the PDT group against 17% of the eplerenone group (p<0.001). Visual acuity did not differ (83.7 letters against 82.8, p=0.555), though retinal sensitivity on microperimetry modestly favoured PDT (25.4 against 23.9 dB, p=0.041). Adverse events occurred in 3 patients (6%) on PDT and 18 (33%) on eplerenone.

Cochrane review of 34 studies (2169 participants) found topical antibiotics gave some symptomatic relief and were effective in eradicating bacteria from the eyelid margin in anterior blepharitis, but the authors concluded there is no strong evidence that any treatment cures chronic blepharitis. Off-label because this label covers the conjunctiva and cornea only, not the lid margin.

Randomized, double-masked, acyclovir-controlled parallel-group multicenter trial across 87 centers, 454 patients with V1 ophthalmic zoster in the intent-to-treat population. One or more ocular manifestations occurred in 142 of 245 (58.0%) on famciclovir 500 mg three times daily versus 114 of 196 (58.2%) on acyclovir 800 mg five times daily, odds ratio 0.99 (95% CI 0.68 to 1.45), with no significant difference in severe or non-severe manifestations, in the prevalence of individual ocular manifestations, or in visual acuity loss. The comparator was acyclovir, not placebo, so the trial establishes similar efficacy rather than a treatment effect size. Timing is the actionable variable: a review of herpes zoster antivirals states that acyclovir, valacyclovir and famciclovir started within 72 hours of acute rash onset significantly shorten acute pain, viral shedding, rash, and acute and late-onset anterior segment complications, and that valacyclovir and famciclovir also reduce the incidence and severity of postherpetic neuralgia, but that none of these agents prevents it.

The IDSA candidiasis guideline recommends this regimen for fluconazole-susceptible isolates in chorioretinitis with or without vitritis, and grades both as a strong recommendation on low-quality evidence. With vitritis the same systemic regimen is given plus intravitreal amphotericin B deoxycholate 5 to 10 mcg/0.1 mL sterile water or voriconazole, and vitrectomy is considered. The label's tissue penetration table lists no ocular compartment; the supporting ocular pharmacokinetics come from a rabbit study in which aqueous and vitreous concentrations were at least 70% of serum in non-inflamed eyes, not from human data.

A systematic review with network meta-analysis of needling revision compared mitomycin C, 5-fluorouracil and no antimetabolite at all. It found no significant difference between them in intraocular pressure at 12 months or latest follow-up, complication rates, qualified or complete success, or the number of re-needling cases. Six studies met inclusion and only one was randomised, and the authors attribute an overall low quality of evidence to that design mix and call for further research. So this is no difference SHOWN, not a difference ruled out.

Non-randomized prospective interventional study of 29 eyes with PCR-confirmed CMV anterior segment infection (23 anterior uveitis, 6 endotheliitis) treated with the 0.15% gel 5 times daily: at 6 weeks 26 of 29 eyes had undetectable aqueous CMV titre and no anterior chamber activity, the 2 eyes that worsened were non-compliant, but mean aqueous ganciclovir concentration was 17.4 plus or minus 30.6 ng/mL, which the authors state is below the 50% inhibitory dose for CMV replication. A systematic review and meta-analysis of 23 studies reported good clinical response of acute CMV anterior uveitis to topical 0.15% gel in 90% (95% CI 74 to 100%), comparable to oral valganciclovir at 95% (95% CI 88 to 100%), but found that chronic anterior uveitis and endotheliitis required escalated concentration and frequency, with endotheliitis series using topical 0.5% to 2% ganciclovir rather than 0.15%, and that recurrence after stopping maintenance was common.

Hydroxyamphetamine releases noradrenaline from an intact third-order neuron, so it separates where cocaine cannot. In 54 patients with Horner syndrome, those with postganglionic damage dilated LESS on the affected side, while almost all with preganglionic lesions dilated MORE. A companion study of 26 normal subjects established the baseline that makes the reading interpretable: a mean 1.96 mm of dilation, and near-symmetric between an individual's two eyes at a mean interocular difference of -0.087 mm, so between-subject variation is much larger than within-subject. Read this row for the pharmacology and the history: the single-agent product it depends on is not available, which is why localisation is now usually left to imaging.

A network meta-analysis of 17 studies (12 retrospective, 5 randomized) in 1492 patients with stage II to IV idiopathic macular hole found that peeling with 0.25% of this dye performed worse for hole closure than peeling with no dye at all, while 0.05% brilliant blue G, 0.15% trypan blue, 0.5% and 0.05% of this dye all outperformed 0.25%; the authors suggest 0.05% as a good choice for surgeons who prefer this dye, and call for large high-quality randomized trials to confirm the ranking. A separate meta-analysis of 9 studies and 846 eyes found better postoperative acuity with brilliant blue G than with this dye (mean difference -0.10 logMAR, 95% CI -0.16 to -0.03, P=0.004, negative favoring brilliant blue G) but no significant difference in closure rate (OR 1.98, 95% CI 0.71 to 5.48, P=0.19).