Pressure to practice evidence-based medicine is increasing and has the potential to reduce malpractice claims. Sometimes the evidence may prove a specific therapy to be ineffective, but practice says it is effective. In Medicine, however, if you do not trust the evidence, you may expose yourself and your patients to untoward consequences. When we face a complex problem, most of the time it is better to rely on scientific evidence rather than on expert personal opinion.

Ocular surface squamous neoplasia (OSSN) encompasses a range of corneal and conjunctival lesions from intraepithelial dysplasia to invasive squamous cell carcinoma. The mainstay of treatment for OSSN has traditionally been surgical excision with wide margins and cryotherapy. Increasing evidence on the efficacy and safety of medical therapy and the avoidance of surgical complications has made topical chemotherapy increasingly popular among corneal specialists. The most common topical agents used for the treatment of OSSN include mitomycin C, 5-fluorouracil, and interferon α2b. Herein, we review recent advances in the surgical and medical management of OSSN and discuss advantages and disadvantages of each approach. The role of ultra high-resolution optical coherence tomography in the diagnosis and treatment of primary and recurrent OSSN lesions is also discussed.

Acanthamoeba keratitis is a sight-threatening disease that carries a favorable prognosis when diagnosed and treated early in the disease course. In some countries, the disease is more common than fungal keratitis, thus showing the importance of knowing and understanding this intriguing infection.

Currently, there are no level one evidence-based studies comparing systemic vs topical therapy for the management of fungal keratitis. Information on systemic efficacy alone or in combination with topical use is rare. Selection of the most appropriate antifungal for fungal keratitis remains a challenge, hindered by the diverse clinical presentation in fungal keratitis, delay in clinical and laboratory diagnosis, limited supply of effective antifungals, lack of ocular pharmacological profiles for current antifungals, nonstandard dosing intervals/routes of administrations, expanding list of causative agents, geographic diversity and the emergence of resistance. Efficacy is gleamed from personal observations, clinical experience, literature reviews, or retrospective data from small or single cases studies and or chart reviews. Taken together, the level of existing evidence is insufficient to determine the role of systemic vs topical therapy for fungal keratitis. Topical therapy remains the standard for treatment of fungal keratitis. Adjunctive therapy with oral or intravenous antifungals may be required for severe or recalcitrant ulcers. Well-powered randomized clinical trials involving diverse and common topical vs systemic therapies are needed to address this question.

Bacterial keratitis (BK) is one of the most frequent causes for emergency hospital admissions.¹ Identifying the causative microorganism promptly and properly is mandatory to achieve acceptable outcomes. Nevertheless, appropriate initial management of these cases requires laboratory-based diagnosis and even a modest laboratory set may not always be available at some clinical settings.

Blepharitis is one of the most common disorders encountered in ophthalmology. Despite this, it can often be overlooked and misdiagnosed. Blepharitis can manifest as anterior and/or posterior disease. The form of blepharitis can be determined based on patient symptoms or clinical presentation. An appropriate treatment plan can be made once the form of blepharitis is elucidated. Three key strategies should be addressed in the treatment of blepharitis: (1) management of symptoms, (2) control of any inflammation that is present to prevent long-term damage, and (3) prevention of recurrence. This review focuses on the treatment of this disease as well as suggestions for treating the most severe cases while keeping these goals in mind.