Dry eye syndrome is one of the most common causes that bring patients to eye clinics. It has different etiologies; however, the clinical manifestation and treatment modalities are nearly the same. Different medical and surgical approaches have been carried out to preserve the vision and relieve discomfort. Management of dry eye syndrome involves a close partnership between the physician and the patient in which proper application of therapeutic, measures and previous experimentations are all important ingredients.      

Background and aim: In spite of many side effects of corticosteroids on patients, they are commonly used for vernal KERATOCONJUNCTIVITIS (VKC) treatment. Corneal morbidity along with steroid related complications may lead to permanent visual impairment. Therefore, the aim of this study was to evaluate the effect and safety of low dose of topical mitomycin C (MMC) on VKC. Methods: In this randomized clinical trial study, 25 cases of vernal KERATO CONJUNCTIVITIS that had been referred to ophthalmology clinic of Shahrekord Medical University were selected and divided into two groups. Group 1 received mitomycin C 0.01% (n=13) and group 2 received placebo (n=12) 3 times per day for two weeks. Symptoms (Itching, foreign body sensation tearing, photophobia, discharge) & signs (hyperemia punctuate kereatitis, trantas spots and limbal edema) were recorded on the day of presentation, 2 & 4 weeks after treatment period. Mann Whitney test was used to evaluate severity of symptoms and signs in 2 groups. Results: No statistically significant difference was observed in severity of symptoms and signs at the time of presentation between two groups. After two weeks treatment, patients in the MMC group showed significant decrease in photophobia, tearing, foreign body sensation, discharge, hyperemia, punctuate kereatitis, limbal edema and trantas spots compared to the placebo group (P<0.05). No adverse effect of MMC was observed after two weeks. Conclusion: Short term usage of low dose of topical MMC is an effective and safe way to control acute exacerbations in patients with severe VKC.

CONJUNCTIVITIS is a commonly encountered condition in ophthalmology clinics throughout the world. In the management of suspected cases of CONJUNCTIVITIS, alarming signs for more serious intraocular conditions, such as severe pain, decreased vision, and painful pupillary reaction, must be considered. Additionally, a thorough medical and ophthalmic history should be obtained and a thorough physical examination should be done in patients with atypical findings and chronic course. Concurrent physical exam findings with relevant history may reveal the presence of a systemic condition with involvement of the conjunctiva. Viral CONJUNCTIVITIS remains to be the most common overall cause of CONJUNCTIVITIS. Bacterial CONJUNCTIVITIS is encountered less frequently and it is the second most common cause of infectious CONJUNCTIVITIS. Allergic CONJUNCTIVITIS is encountered in nearly half of the population and the findings include itching, mucoid discharge, chemosis, and eyelid edema. Long-term usage of eye drops with preservatives in a patient with conjunctival irritation and discharge points to the toxic CONJUNCTIVITIS as the underlying etiology. Effective management of CONJUNCTIVITIS includes timely diagnosis, appropriate differentiation of the various etiologies, and appropriate treatment.

Purpose: To report a patient with factitious (self infected) CONJUNCTIVITIS.Case Report: A 16-year-old girl presented with pain, redness and edema of lids of her left eye. After exclusion of ocular pathologies, self inflicted CONJUNCTIVITIS was diagnosed based on the underlying psychological and social problems of the patient.Conclusion: After exclusion of ocular pathologies, self inflicted CONJUNCTIVITIS should be considered in subjects who are psychologically disturbed and have a gain in assuming the sick role.

Purpose: To report a patient with orbital lymphoma masquerading as chronic CONJUNCTIVITIS with retrobulbar involvement. Patient and findings: A 55-year-old man was referred to an ophthalmologist due to, redness and swelling of the right conjunctiva from 8 months before. The patient was treated with a diagnosis of chronic CONJUNCTIVITIS but was referred to Imam Hossein Hospital because of no response to medial treatment and enlargement of the lesion and decrease in visual acuity. On funduscopy, we noticed the compression effect of a retrobulbar mass. Low grade B cell lymphoma was documented by biopsy. The patient was referred to a radiotherapist for treatment. Conclusion: Conjunctival lymphoma should be included in the differential diagnosis of chronic CONJUNCTIVITIS. Persisting signs and symptoms of CONJUNCTIVITIS not responding to standard treatment should prompt biopsy.

Acanthamoeba species are vision-threatening agents by causing cornea infections known as Acanthamoeba keratitis. A 5 year-old kid with the complaints of erythema, eyelid edema, inflammation, limitation of eye movements in the right eye, and having no history of wearing contact lenses or trauma, was diagnosed of Acanthamoeba CONJUNCTIVITIS through laboratory examinations in the Ophthalmology clinic. The visual sharpness of the patient improved after the treatment. A 44 year-old female patient suffering from pain, stinging, irritation, and inability to see in the left eye with the history of wearing contact lenses or trauma was diagnosed of Acanthamoeba keratitis through laboratory examinations. The agent was isolated and identified as "A. castellani" in the Genotype "T2". Examination of the left eye on the 15th day of treatment indicated that all complaints disappeared except for the cataract originated visual loss. However, the first diagnosis of Acanthamoeba keratitis appeared in the literature on a case with no history of wearing contact lenses and trauma it is found to be attention grabbing. We think that Acanthamoeba should not be ignored among microbial agents that cause eye infection with or without trauma and contact lens usage history.