PURPOSE: Ten years after the first Global Consensus on Keratoconus and Ectatic Diseases, this updated edition revisits key issues, incorporates advances in new technologies, and integrates the expertise of corneal and re...PURPOSE: Ten years after the first Global Consensus on Keratoconus and Ectatic Diseases, this updated edition revisits key issues, incorporates advances in new technologies, and integrates the expertise of corneal and refractive surgeons from 12 international societies. This initiative aimed to establish a consensus among global ophthalmology experts, including corneal and refractive specialists from 6 continents, on the definition, diagnosis, staging, clinical management, and surgical treatment of keratoconus and ectatic corneal diseases. METHODS: The Delphi method consisted of 4 rounds of questionnaires, supplemented by a face-to-face meeting. A total of 128 ophthalmologists participated, with 3 main coordinators and 125 keratoconus experts distributed across 7 panels: definition/diagnosis/staging, clinical treatment and noninvasive visual rehabilitation, cross-linking for progression, and invasive visual rehabilitation (including therapeutic approaches, improved corrected distance visual acuity, keratoplasty techniques, and cataract surgery in keratoconus). The consensus threshold was defined as at least two-thirds agreement. RESULTS: A significant consensus was reached on topics such as definitions, diagnostic and progression criteria, and management strategies for keratoconus and other ectatic corneal disorders. A comprehensive approach was outlined, encompassing both nonsurgical and surgical treatments, organized in a group-based approach. In addition, major agreements and disagreements across the 7 subcommittees are outlined in individual tables. CONCLUSIONS: This updated Global Consensus provides revised definitions, expert statements, and recommendations for diagnosing and managing keratoconus and other ectatic corneal diseases. It benefits from broader participation, with more refractive surgeons and greater representation from major ophthalmic societies across 6 continents, capturing a wider range of global clinical perspectives than the prior report.
PURPOSE: The aim of this study was to evaluate recurrent ectasia as a long-term complication after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) and to further characterize its diagnostic c...PURPOSE: The aim of this study was to evaluate recurrent ectasia as a long-term complication after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) and to further characterize its diagnostic criteria and associated risk factors. METHODS: This retrospective study included 136 eyes (50 PK, 86 DALK) with at least 3 years of follow-up after complete suture removal. Corneal tomography was performed at standardized intervals, and recurrence was defined based on modified Global Delphi criteria, incorporating keratometric, pachymetric, and visual changes. In addition, symmetry indices, elevation parameters, and Kmax values of the anterior and posterior corneal surfaces were evaluated. RESULTS: Recurrent ectasia was detected in 28 eyes (20.6%), with rates of 22.1% after DALK and 18.0% after PK, with no statistically significant difference between the groups (P = 0.569). The mean time to recurrence was 40.7 ± 26.0 months after suture removal. Smaller donor and host corneal diameters were significantly associated with recurrent ectasia in both DALK and PK groups, and in the overall cohort (all P < 0.001). Progressive changes in K1 (P = 0.049), K2 (P = 0.002), Kmean (P = 0.002), minimum corneal thickness (P = 0.021), apex thickness (P = 0.004), and astigmatic vectors (P = 0.014) were identified as key diagnostic markers in the overall cohort, whereas Kmax was not reliable at the final visit (P = 0.733). CONCLUSIONS: These findings suggest that smaller graft diameter was identified as a significant risk factor for recurrence. Objective keratometric and pachymetric criteria may improve early detection and standardization of postoperative follow-up.
PURPOSE: To describe the visual, anatomical, and vitreoretinal (VR) outcomes after Boston Keratoprosthesis (BKpro) type I and type II implantation. METHODS: A retrospective chart review was conducted of BKpro surgeries a...PURPOSE: To describe the visual, anatomical, and vitreoretinal (VR) outcomes after Boston Keratoprosthesis (BKpro) type I and type II implantation. METHODS: A retrospective chart review was conducted of BKpro surgeries at Massachusetts Eye and Ear between May 2016 and November 2024. RESULTS: Ninety-one eyes from 89 patients (mean age: 67.9 ± 16.5 years) were analyzed. The median presenting visual acuity was 2.6 logMAR [range (R): 0.38 to 4.00] that improved to 1.18 (R: 0.00-4.00). Type I BKpros (80.2%) were more common than type II (19.8%). Median duration of follow-up was 37.5 months (IQR: 16.9-67.7). VR complications were noted in 61.5% of eyes-64.3% in type I and 50.0% in type II. Complications in descending incidence include retroprosthetic membrane (8.28 events/100 years), epiretinal membrane (6.62/100 eye-years), endophthalmitis (5.24/100 eye-years), retinal detachment (4.42/100 eye-years), cystoid macular edema (4.42/100 eye-years), vitreous hemorrhage (3.59/100 eye-years), vitritis (2.48/100 eye-years), and choroidal hemorrhage (0.83/100 eye-years). Of those with VR complications, 82% had one occur in the first year. CONCLUSIONS: Both type I and type II BKpros demonstrated improved visual acuity. However, VR complication rates are high, particularly in the first year, suggesting a need for close multidisciplinary monitoring. Treatment of these sequalae remains challenging with often needing multiple procedures.
INTRODUCTION: Corneal ectasias are progressive diseases that, if untreated, can cause severe vision loss. Among several causes, eye rubbing is increasingly recognized. Many reports link eye rubbing to ectasia development...INTRODUCTION: Corneal ectasias are progressive diseases that, if untreated, can cause severe vision loss. Among several causes, eye rubbing is increasingly recognized. Many reports link eye rubbing to ectasia development, but few describe the potential for reversal after cessation. PATIENT AND CLINICAL FINDINGS: A 68-year-old White man presented with subjective eye redness, itchiness, and progressively worsening vision for 5 months. Corneal tomography showed a superior corneal ectasia with central thinning and irregular astigmatism. DIAGNOSIS, INTERVENTION, AND OUTCOMES: The ectasia was attributed to repetitive mechanical trauma from frequent eye rubbing. Treatment included antihistamine drops, an eyelid scrub for suspected allergic conjunctivitis, and counseling on stopping eye rubbing. At 1 week, symptoms improved; at 1 month, corneal tomography showed significant improvement. CONCLUSIONS: Early identification of eye rubbing in patients developing corneal ectasia is critical. Stopping the behavior may halt progression and potentially reverse early corneal changes.
PURPOSE: To characterize national trends in corneal tissue recovery, release, utilization, and discard across the United States, quantify seasonality and the COVID-19 shock, and identify associations between donor featur...PURPOSE: To characterize national trends in corneal tissue recovery, release, utilization, and discard across the United States, quantify seasonality and the COVID-19 shock, and identify associations between donor features and tissue discard. METHODS: We conducted a retrospective analysis of Eye Bank Association of America data from 2011 to 2024. Temporal trends in tissue recovery, release, utilization, and discard (defined as prerelease or postrelease) were modeled with regression-based analyses. Seasonality was assessed with decomposition and month-of-year models. Multivariable regressions were used to investigate associations between donor characteristics and tissue discard. RESULTS: Although national recovery volumes increased from 2011 to 2024, the likelihood of utilization declined. The proportion of corneas discarded prerelease fell, but postrelease discard rose, indicating a shift of attrition downstream. Monthly activity showed consistent troughs in December and a pronounced dip during March-May 2020. Among reasons for prerelease discard, shares attributed to tissue quality, failed testing, serologic findings, and medical record/autopsy findings increased between 2011 and 2024. Postrelease discard because of tissue damage during processing and handling increased, whereas discard because of surgeon or recipient issues and expiration decreased. In multivariable models, older donor age and causes of death including cancer, trauma, and cardiac disease were associated with higher probabilities of prerelease discard. CONCLUSIONS: Corneal graft attrition has shifted downstream, with rising discard after tissue release despite improved prerelease yield. These data may shape strategies to maximize the efficiency of corneal transplantation. Further research is needed to determine whether shifts in tissue utilization have corresponded with improved patient outcomes.
PURPOSE: To assess sociodemographic disparities present in the treatment of keratoconus based on several factors including race, ethnicity, and sex in the United States. METHODS: This was a retrospective cohort study usi...PURPOSE: To assess sociodemographic disparities present in the treatment of keratoconus based on several factors including race, ethnicity, and sex in the United States. METHODS: This was a retrospective cohort study using aggregated patient data collected between January 2000 to December 2025 on the TriNetX platform. Patients with keratoconus were identified and stratified into groups separated by ethnicity, race, and sex. Propensity-score matching was performed using baseline characteristics to ensure comparability. Period prevalence of keratoconus in 2025 and risk and hazard ratios with 95% confidence intervals for patients who received either any type of keratoplasty, penetrating keratoplasty, anterior lamellar keratoplasty, or corneal cross-linking (CXL) between cohorts were calculated. RESULTS: Period prevalence was found to be 0.108% in 2025. After matching, Black patients were more likely to undergo keratoplasty (RR, 1.685; 95% CI, 1.55-1.832) and less likely to undergo CXL (RR, 0.5; 95% CI, 0.445-0.562) when compared with White patients. Patients of Hispanic ethnicity were more likely to undergo keratoplasty (RR, 1.298; 95% CI, 1.139-1.479, P < 0.0001) and less likely to undergo CXL (RR, 0.666; 95% CI, 0.585-0.759, P < 0.0001). In contrast, Asian patients were less likely to undergo keratoplasty (RR, 0.704; 95% CI, 0.522-0.95, P = 0.0208). CONCLUSIONS: This study sheds further light on disparities that may exist for Black and Hispanic patients regarding keratoconus management in the United States. In particular, discrepancies exist in the utilization of treatment options involving keratoplasty in contrast to less-invasive procedures such as CXL.
PURPOSE: Corneal impression membranes (CIMs) are an easier and safer method to obtain samples in microbial keratitis than corneal scrapes (CS). This study compares the level of agreement in the isolation rates of bacteri...PURPOSE: Corneal impression membranes (CIMs) are an easier and safer method to obtain samples in microbial keratitis than corneal scrapes (CS). This study compares the level of agreement in the isolation rates of bacteria using CIM and CS in patients with suspected microbial keratitis. METHODS: Retrospective review of 116 consecutive patients with suspected microbial keratitis requiring corneal sampling. Both CS and CIM were performed for each case. The level of agreement in microbial isolation rates between the paired samples was compared using Cohen kappa. RESULTS: Microorganisms were isolated from 74/116 (63.8%) of CIM samples and in 84/116 (72.4%) of CS samples (P = 0.12). The commonest bacterial isolates were Pseudomonas aeruginosa [20.0% (CIM) vs. 20.7% (CS); P = 0.87] and Staphylococcus species. The commonest coagulase-negative Staphylococcus species were Staphylococcus epidermidis (24.1% vs. 25.9%; P = 0.88) and Staphylococcus warneri (3.4% vs. 7.8%; P = 0.25). Staphylococcus aureus was isolatedin 6.9% versus 7.8% (P = 1.00). There was no isolation of fungi or acanthamoeba in any of the 116 CIM or CS samples. Mixed growth was found in 14.7% of CIM samples and 28.4% of CS samples (P = 0.02). The level of agreement between CIM and CS was 0.89 (P < 0.001) for Pseudomonas aeruginosa, 0.04 (P = 0.71) for Staphylococcus epidermidis, 0.56 (P < 0.001) for Staphylococcus aureus, and 0.11 (P = 0.19) for Staphylococcus warneri. CONCLUSIONS: CIM is an effective method in collecting corneal samples in patients with suspected microbial keratitis, with a high level of agreement with CS in the isolation of Pseudomonas aeruginosa, and a moderate level of agreement in the isolation of Staphylococcus aureus.
PURPOSE: To report a novel complication of scleral tattooing: inadvertent lacrimal gland infiltration leading to dacryoadenitis and pigmented dacryorrhea. METHODS AND RESULTS: A case report of a 25-year-old woman who pre...PURPOSE: To report a novel complication of scleral tattooing: inadvertent lacrimal gland infiltration leading to dacryoadenitis and pigmented dacryorrhea. METHODS AND RESULTS: A case report of a 25-year-old woman who presented to the emergency department with persistent unilateral eye pain, photophobia, and a history of bright blue tears 4 months after undergoing a scleral tattooing procedure. Diagnosis was confirmed via clinical ophthalmological examination and contrast-enhanced orbital computed tomography (CT). Examination revealed teal tattoo pigment within the palpebral lobe of the ipsilateral lacrimal gland, which was enlarged and tender, consistent with dacryoadenitis. Pigment was also noted in the limbal vasculature. Orbital CT confirmed anterior globe pigment deposition without evidence of globe penetration, cellulitis, or abscess. The patient's symptoms resolved with a conservative management strategy of topical antibiotic-steroid drops and lubrication. CONCLUSIONS: This case expands the known spectrum of scleral tattoo-related complications to include lacrimal gland involvement and pigmented tearing. It demonstrates that severe adnexal morbidity can occur even in the absence of globe penetration. Ophthalmologists should be aware of this potential complication and carefully examine the lacrimal system in patients with a history of ocular body modification. This report underscores the substantial risks of scleral tattooing and reinforces the need for patient counseling against the procedure.
PURPOSE: To evaluate the effects of topical recombinant human nerve growth factor (rhNGF) in pediatric neurotrophic keratopathy (NK), with specific attention to corneal opacities, amblyopia, and visual outcomes. METHODS:...PURPOSE: To evaluate the effects of topical recombinant human nerve growth factor (rhNGF) in pediatric neurotrophic keratopathy (NK), with specific attention to corneal opacities, amblyopia, and visual outcomes. METHODS: This retrospective study included 10 pediatric patients with NK refractory to conventional therapy who received topical rhNGF for 8 weeks. The cohort had complex multisystem comorbidities and frequently required bedside examinations with limited cooperation; therefore, standardized imaging, quantitative grading, and clinic-based photography were often not feasible. RESULTS: Mean age was 5.1 ± 4.8 years, and 80% of patients were within the amblyogenic period. Mean follow-up was 71.7 ± 45.6 weeks. All patients presented with persistent epithelial defects and corneal opacities, central in 80% of cases. Baseline best-corrected visual acuity was 0.75 ± 0.23 logMAR. Complete epithelial healing was achieved in 9 of 10 patients (90%), with clinician-assessed qualitative improvement in corneal opacity appearance in 6 patients (60%) within 8 weeks. Baseline best-corrected visual acuity did not significantly improve at week 8 or at final follow-up. Six patients demonstrated asymmetric astigmatism greater than +1.50 diopters. One patient with advanced stage 3 NK did not achieve epithelial healing and had limited follow-up because of international referral. CONCLUSIONS: Topical rhNGF was effective and well tolerated in pediatric NK, producing rapid epithelial healing and qualitative improvement in corneal opacity appearance. Limited visual recovery likely reflects preexisting central stromal scarring and amblyopia, emphasizing the importance of early NK recognition and timely rhNGF initiation to preserve visual potential during childhood visual development and long-term clinical decision making globally care.
PURPOSE: Herpes simplex virus (HSV) and varicella zoster virus (VZV) are known causes of chronic and recurrent interstitial keratitis. Determination of active corneal inflammation is important for appropriate management....PURPOSE: Herpes simplex virus (HSV) and varicella zoster virus (VZV) are known causes of chronic and recurrent interstitial keratitis. Determination of active corneal inflammation is important for appropriate management. This study aimed to investigate features of clinically active herpetic interstitial keratitis (HIK) by anterior segment optical coherence tomography (AS-OCT). METHODS: Twenty-seven patients with active HIK (17 with HSV, 10 with VZV) and AS-OCT imaging were retrospectively identified. Five patients also had stromal scarring (SS), presumably from prior HIK episodes. An additional 4 patients with SS, but without a history of HIK, were also identified. The AS-OCT images were analyzed qualitatively, followed by an automated segmentation analysis. Deidentified images were shown to 3 masked graders after a training module, and their diagnoses were compared with slit-lamp diagnoses. RESULTS: Qualitative analysis of AS-OCT images of active HIK revealed anterior stromal hyperreflectivity, often with a hazy border and convex posterior contour comparable with "posterior bowing" historically seen on slit lamp. Borders were sharper and typically more linear for SS. Automated segmentation analyses identified that epithelium overlying the stromal area of interest was thicker in SS than HIK. Survey results revealed a high degree of correlation with slit-lamp diagnoses. CONCLUSIONS: AS-OCT may be a useful adjunct to slit-lamp examination in the evaluation of active inflammation in patients with a history of HIK. Hyperreflectivity, hazy borders, convex contour, and epithelial thickness may be informative. Future studies could elucidate a role for deep learning algorithms in diagnosing active HIK.
PURPOSE: The aim of this study was to investigate whether long-term topical application of intraocular pressure (IOP) lowering medication has an effect on corneal biomechanical properties in primary open-angle glaucoma (...PURPOSE: The aim of this study was to investigate whether long-term topical application of intraocular pressure (IOP) lowering medication has an effect on corneal biomechanical properties in primary open-angle glaucoma (POAG). METHODS: This study included 225 White European patients with POAG. Biomechanical measurements were performed using the Scheimpflug analyzer Corvis ST. Each patient underwent a detailed medical history, an ophthalmic examination, and a 24-hour IOP profile. Further examinations were performed using Heidelberg retinal tomography, endothelial cell microscopy, and Pentacam. The results were compared with a group of 78 healthy subjects matched for age, pachymetry, and IOP. RESULTS: Most dynamic corneal response parameters showed significant differences between patients with POAG and healthy subjects. When comparing patients with POAG with and without the use of prostaglandin analogs (PGAs), differences were observed in second applanation deflection length (P = 0.002), second applanation deflection area (P = 0.001), and deformation amplitude ratio max 1 mm (P = 0.001). In contrast, the use of beta-blockers, carbonic anhydrase inhibitors, alpha agonists, and miotics led to hardly any changes in corneal biomechanics. CONCLUSIONS: Long-term use of PGAs is not only associated with a reduction in corneal thickness but also may affect the biomechanical properties of the cornea.
PURPOSE: Keratoplasty is the most common transplantation worldwide, yet donor tissue shortages persist. This study evaluates how external hospital collaborations affect corneal donation rates, donor demographics, and tis...PURPOSE: Keratoplasty is the most common transplantation worldwide, yet donor tissue shortages persist. This study evaluates how external hospital collaborations affect corneal donation rates, donor demographics, and tissue quality and identifies operational barriers to optimizing procurement. METHODS: A retrospective analysis of corneal donation records from the LIONS Eye Bank Baden-Württemberg (2004-2024) was performed, including donors from the University Medical Center Freiburg (internal) and 14 collaborating hospitals (external). Donation rates, donor characteristics, death-to-retrieval times, and endothelial cell density were compared. Logistic regression analysis was used to assess factors influencing transplantation likelihood. Separately, a structured 6-item questionnaire evaluated collaboration quality, operational efficiency, and key challenges among cornea bank staff. RESULTS: Of 7054 donors (14,038 corneas), 64.7% were internal and 35.3% external. Median donor age was 73 years. Over time, external donations rose steadily, exceeding 100 annually since 2012, with hospitals within 20-km driving distance of the eye bank contributing most external donors. Recent donation rates were higher internally (15.8%) than externally (5.4%). Analysis of 11,059 corneas showed shorter death-to-retrieval times for external donors (22.8 vs. 25.1 h) but lower endothelial cell density (2190 vs. 2263 cells/mm2). Pseudophakia, older donor age, and longer death-to-retrieval times significantly reduced transplantation likelihood. Staff reported good collaboration (88.9%), but assessing external donors took at least twice as long. CONCLUSIONS: External collaborations substantially increased donor numbers over 2 decades, but donation rates remain lower than internal sites. Overcoming logistical barriers could unlock the full potential of external networks, strengthen local tissue supply, and reduce reliance on imported grafts.
PURPOSE: To evaluate the impact of the FDA approval of corneal crosslinking (CXL) on April 18, 2016, on rates of penetrating keratoplasty (PK) and anterior/lamellar keratoplasty (ALK) for the treatment of keratoconus. ME...PURPOSE: To evaluate the impact of the FDA approval of corneal crosslinking (CXL) on April 18, 2016, on rates of penetrating keratoplasty (PK) and anterior/lamellar keratoplasty (ALK) for the treatment of keratoconus. METHODS: We conducted a retrospective analysis of 18,467 matched patients with keratoconus using the TriNetX US Collaborative Network. Of these, 1823 received a PK before CXL approval (9.76%) and 718 received a PK after approval (3.89%). Risk differences and risk ratios were calculated to assess changes in keratoplasty frequency associated with CXL approval. RESULTS: PK procedures significantly decreased after CXL approval. The PK rate was 9.76% before April 18, 2016, and 3.89% thereafter, corresponding to a risk difference of 5.87% (P < 0.01) and risk ratio of 2.51 [95% confidence interval (CI): 2.31-2.73]. Similarly, ALK procedures declined, with a preapproval rate of 3.88% compared with 1.16% postapproval, yielding a risk difference of 2.72% (P < 0.001) and risk ratio of 3.34 (95% CI: 2.87-3.88). CONCLUSIONS: FDA approval of CXL was associated with a marked reduction in PK and ALK procedures among patients with keratoconus in the United States, reflecting a shift in surgical management after CXL adoption.
PURPOSE: To describe the risk factors, clinical course, and characteristics of 5 cases of acute calcific band keratopathy (BK) after the use of recombinant human nerve growth factor for neurotrophic keratitis. METHODS: A...PURPOSE: To describe the risk factors, clinical course, and characteristics of 5 cases of acute calcific band keratopathy (BK) after the use of recombinant human nerve growth factor for neurotrophic keratitis. METHODS: A single-center retrospective chart review of 43 eyes of 43 patients previously diagnosed with neurotrophic keratitis from April 2021 to October 2023 was conducted. All patients had previously completed at least one 8-week course of topical cenegermin 0.002%. Five of the 43 cenegermin-treated eyes that developed BK are included in this series. RESULTS: The incidence of BK was 11.6%. The median time from treatment initiation to BK was 8 weeks. A corneal biopsy confirmed the presence of calcification in 2 cases. All 5 patients had persistent calcium deposits after discontinuing treatment. Prolonged epithelial defect healing time while on treatment was observed in patients who developed BK. CONCLUSIONS: BK was observed after cenegermin use. Herein, we report a series of 5 cases, which occurred at the same institution. Ethylenediaminetetraacetic acid chelation therapy had variable results, with 4 out of 5 patients requiring repeated surgical intervention because of multiple recurrences of BK.
PURPOSE: The objective of this study is to report the impact of social and demographic factors on pediatric keratoplasty outcomes at a tertiary care center in India. We explore nonclinical factors that may influence outc...PURPOSE: The objective of this study is to report the impact of social and demographic factors on pediatric keratoplasty outcomes at a tertiary care center in India. We explore nonclinical factors that may influence outcomes to optimize surgical success and visual acuity in pediatric patients. METHODS: We conducted an observational, cross-sectional study of patients aged 16 years or younger who underwent keratoplasty at a single institution in South India. A total of 255 participants were interviewed with their families in person or by telephone using a voluntary, institutional review board-approved electronic survey. Demographic data were self-reported, and participants' aggregate clinical outcomes were obtained through chart review. Primary outcome measures were graft clarity and functional vision at the final follow-up. RESULTS: Among 255 participants, 137 (53.7%) had bilateral congenital corneal disease. The mean duration of follow-up was 74.4 ± 47.1 months, during which 184 patients (72.2%) achieved clear grafts in operated eyes. Multivariate analysis revealed significant associations between surgical success and type of surgery (Category 1 P = 0.001; Category 2 P = 0.006) and government support (Category 1 P = 0.006; Category 2 P = 0.013). LogMAR visual acuity improved from 1.43 ± 0.54 before keratoplasty to 1.08 ± 0.73 at the last follow-up visit (P < 0.001). CONCLUSIONS: Surgical success in pediatric keratoplasty is associated with demographic factors such as the father's education, consanguinity, and fewer financial dependents. These findings highlight the importance of health literacy and familial support in improving pediatric keratoplasty outcomes.
PURPOSE: To evaluate whether incidental ultraviolet (UV) radiation exposure is associated with subclinical ocular surface inflammation and corneal immune cell changes in healthy young adults, using conjunctival UV autofl...PURPOSE: To evaluate whether incidental ultraviolet (UV) radiation exposure is associated with subclinical ocular surface inflammation and corneal immune cell changes in healthy young adults, using conjunctival UV autofluorescence (CUVAF) as a biomarker of UV exposure. METHODS: Fifty-two healthy adults (18-35 years) were examined. CUVAF of the right eye was imaged and quantified. Ocular surface symptoms and signs were assessed using the ocular surface disease index, and the Efron grading scales for bulbar redness and upper tarsal conjunctival roughness. In vivo confocal microscopy was conducted to determine the density of immune cells without visible dendrites (woDCs), with dendrites (wDCs), and globular immune cells in the central and peripheral cornea. Central corneal nerve parameters were also assessed. Group comparisons were made between eyes with and without CUVAF, and correlations with CUVAF area were conducted. RESULTS: CUVAF was present in 60% of eyes. Individuals with CUVAF demonstrated significantly greater bulbar redness and upper tarsal conjunctival roughness compared with those without. Central globular immune cell density was higher in CUVAF eyes (P < 0.05), and both woDC and wDC densities were significantly elevated in the superior cornea (P < 0.01). No differences were observed in central corneal nerve parameters. CONCLUSIONS: Healthy eyes displaying CUVAF exhibit measurable increases in ocular surface inflammation and corneal immune cell density, indicating subclinical inflammatory changes associated with chronic low-grade UV exposure. CUVAF may serve as a clinically accessible marker of early UV-related ocular surface injury.