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Background:High-dose systemic steroids are the primary modality of treatment for idiopathic orbital inflammatory syndrome (IOIS). Occasionally patients experience a relapse of symptoms on tapering steroids or require large doses of steroid, predisposing them to the adverse effects of steroids.Aim:We present our experience with the management of three patients with recalcitrant IOIS, with immunosuppressive therapy, using antimetabolites.Materials and Methods:A retrospective review of the medical records of the patients being reported. Results: Two patients were treated with Methotrexate and one with Azathioprine for a duration of 6-24 months. Two patients were symptom-free three years after stopping the medication. One was doing well clinically with methotrexate therapy alone, when he was lost to follow-up after six months. No adverse effects of immunosuppressive therapy were encountered.Conclusion:High-dose systemic steroid therapy is the first-line treatment for IOIS, but in refractory or steroid-dependent cases, immunosuppressive therapy with antimetabolites is a safe and effective treatment alternative to steroids. However, treatment with antimetabolites warrants close monitoring for complications like bone marrow suppression and liver dysfunction, especially because long-term treatment is required.

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Background and objectiveDry eye disease (DED) is one of the most common reasons why patients seek eye care. With increasing age, widespread adoption of technology, and environmental changes, its prevalence has been on the rise, and will likely increase further. Meibomian gland dysfunction (MGD) is the most common cause of DED; however, for a variety of reasons, it is currently underrecognized. We aimed to determine the etiology of DED from a sample of patients visiting our center with dry eye symptoms and study the characteristics of those diagnosed with MGD. MethodologyWe conducted this prospective observational study from 2016 to 2018. We included patients with two or more dry eye symptoms and excluded those with systemic conditions or structural issues causing dry eye. Each patient underwent a detailed evaluation of the dry eye, including the Ocular Surface Disease Index (OSDI) questionnaire, Oxford corneal staining, Schirmer test 1, tear film break-up time (TBUT), tear meniscus height, and non-contact meibography. All patients subsequently received appropriate treatment. Patients with MGD were evaluated once again after one month. ResultsWe included 250 patients in the study. Their mean (standard deviation) age was 45.3 (16.9) years, and 138 (55%) of them were males. Grittiness and itching were the most common symptoms. MGD was the most common diagnosis, seen in 100 (40%), followed by chronic allergic conjunctivitis. Patients with MGD were more likely to be elderly and had significantly worse DED parameters. Over half of all MGD cases were mild or less severe. With appropriate treatment, all DED metrics improved significantly. ConclusionsMGD was the most common cause of DED in our sample. Patients with MGD were more likely to be elderly and had more severe DED, consistent with other studies in the literature. With specific treatment of MGD, there was a significant improvement in the patients' condition. DED is a growing ocular health issue that causes great detriment to patients' quality of life and finances. Our findings support the need for a detailed evaluation and specific treatment of patients presenting with dry eye symptoms.