Immunomodulation of the Ocular Surface in Severe Dry Eye Disease: Expert-Driven Literature Review on Treatment Strategies with Description of Representative Challenging Cases - PubMed
3 hours ago
- #Ocular Surface
- #Immunomodulation
- #Dry Eye Disease
- Dry eye disease (DED) is a multifactorial inflammatory disorder with tear-film hyperosmolarity, immune activation, and neurosensory dysfunction.
- Severe DED is common in autoimmune diseases like Sjögren syndrome (SS) and rheumatoid arthritis (RA), often resistant to first-line treatments.
- Short courses of topical corticosteroids can rapidly suppress disease flares but require careful stewardship due to potential side effects.
- Immunomodulators such as cyclosporine A (CsA), lifitegrast, and tacrolimus are effective for long-term control by attenuating T-cell-mediated inflammation.
- Newer CsA formulations improve bioavailability and tolerability.
- Challenging cases of autoimmune-related DED were managed with biological tears, lid-based care, punctal plugs, and once-daily CsA.
- Adjunctive measures like oral doxycycline improve meibomian gland function and reduce inflammation.
- Regular follow-up is essential for treatment tapering, safety monitoring, and patient adherence.
- In severe cases, surgical interventions such as conjunctival flap, amniotic membrane transplantation, and penetrating keratoplasty may be required.
- A stepwise treatment regimen is recommended: initial corticosteroids, sustained immunomodulation (CsA as cornerstone), and adjunctive therapies.
- Multidisciplinary coordination and regular monitoring are crucial for long-term ocular surface homeostasis and quality of life.