A Review on Dry Eye Disease Treatment: Recent Progress, Diagnostics, and Future Perspectives

Application of Nanomaterials in the Diagnosis and Treatment of Retinal Diseases

In recent years, nanomaterials have demonstrated broad prospects in the diagnosis and treatment of retinal diseases due to their unique physicochemical properties, such as small-size effects, high biocompatibility, and functional surfaces. Retinal diseases are often accompanied by complex pathological microenvironments, where conventional diagnostic and therapeutic approaches face challenges such as low drug delivery efficiency, risks associated with invasive procedures, and difficulties in real-time monitoring. Nanomaterials hold promise in addressing these limitations of traditional therapies, thereby improving treatment precision and efficacy. The applications of nanomaterials in diagnostics are summarized, where they enable high-resolution retinal imaging by carrying fluorescent probes or contrast agents or act as biosensors to sensitively detect disease-related biomarkers, facilitating early diagnosis and dynamic monitoring. In therapeutics, functionalized nanocarriers can precisely deliver drugs, genes, or antioxidant molecules to retinal target cells, significantly enhancing therapeutic outcomes while reducing systemic toxicity. Additionally, nanofiber materials possess unique properties that make them particularly suitable for retinal regeneration in tissue engineering. By loading neurotrophic factors into nanofiber scaffolds, their regenerative effects can be amplified, promoting the repair of retinal neurons. Despite their immense potential, clinical translation of nanomaterials still requires addressing challenges such as long-term biosafety, scalable manufacturing processes, and optimization of targeting efficiency.

Performance and Safety of a Sodium Hyaluronate, Xanthan Gum, and Osmoprotectants Ophthalmic Solution in the Treatment of Dry Eye Disease: An Observational Clinical Investigation

INTRODUCTION

Dry eye disease (DED) is characterized by an imbalance in the tear film, resulting in symptoms such as dryness, redness, and discomfort. The management of DED involves tear supplements, medications, or surgery in severe cases. To evaluate the clinical performance and safety of a hypotonic ophthalmic solution containing sodium hyaluronate 0.2%, xanthan gum 0.2%, and osmoprotectants (glycine and betaine) for treating DED.

METHODS

This multicenter, prospective, observational clinical investigation included 35 subjects treated with one drop of the ophthalmic solution four times daily. Evaluations were conducted at baseline, on day 14, and at 1 and 3 months. The investigation assessed corneal and conjunctival fluorescein staining (NEI score), hyperemia index (Keratograph®), fluorescein tear film break-up time (TFBUT), best-corrected visual acuity, dry eye symptoms (SANDE), and quality of life (DEQS). Safety was monitored through adverse events, intraocular pressure measurements, and the Investigator Global Assessment of Safety.

RESULTS

Subjects were predominantly female (93.9%), with an average age of 59.9 ± 13.8 years. The ophthalmic solution significantly reduced keratitis lesions with global NEI score decreasing from baseline at 1 month (- 6.67 ± 4.6, p = 0.001) and 3 months (- 7.61 ± 4.0 points; p = 0.001). Conjunctival hyperemia improved significantly after 1 month (- 0.34 ± 0.7 points; p = 0.027), while fluorescein tear film stability increased significantly at 1 (1.85 ± 3.1 s; p = 0.002) and 3 months (1.98 ± 3.4 s; p = 0.001). Symptoms also improved significantly (p = 0.001) at 1 and 3 months (- 29.37 ± 22.2 points and - 26.41 ± 24.0 points, respectively), as did quality of life (- 20.81 ± 15.6 points at 1 month and - 18.43 ± 19.3 points at 3 months; p = 0.001 for both). The safety profile was very good, with no adverse events (only mild ocular discomfort reported in 14.3% of subjects).

CONCLUSIONS

The ophthalmic solution effectively improved DED symptoms and signs, enhancing patients' quality of life while maintaining a good safety profile.

TRIAL REGISTRATION NUMBER

NCT05778942.

Biogenic Amino Acid Cross-Linked Hyaluronic Acid Nanoparticles Containing Dexamethasone for the Treatment of Dry Eye Syndrome

Ocular barriers, poor retention time, and frequent ocular discharge suppress the activity of Dexamethasone. Arginine (Arg) and hyaluronic acid (HA) are crucial for maintaining ocular health because of their unique biological benefits. In this study, we investigated the cationic properties of arginine to develop dexamethasone-loaded HA nanoparticles (ADHA NPs) and evaluated their therapeutic potential in alleviating dry eye syndrome using various reported in-vitro and in-vivo techniques. The ionic cross-linking method was used to prepare ADHA NPs. The ADHA NPs exhibited nearly 94.99 ± 4.16% drug release at the end of 6 h and followed the Korsemeyar-Peppas kinetic model (R2 = 0.9811). Moreover, the developed formulation exhibited a higher water retention capacity, i.e., 86.89 ± 1.41%, and revealed enhanced mucoadhesion characteristics. ADHA NPs also exhibited significant anti-inflammatory effects (p < 0.001) compared to dexamethasone in LPS-induced RAW 264.7 cell lines against proinflammatory cytokines IL-1 β, NO and TNF-α. Furthermore, cell line studies in HCECs (human corneal epithelial cells) showed cytocompatibility and a dose-dependent uptake of ADHA NPs. ADHA NPs also maintained the cell integrity against 0.005% benzalkonium chloride (BAC) induced dry eye model on HCECs. Further, the Schirmer tear test showed twofold enhanced tear production in the developed formulation, and ADHA NPs seem to maintain the uniform structure of the tear. In vivo, drug retention studies ensured the good retention properties of ADHA NPs up to 12 h. In conclusion, ADHA NPs, because of their anti-inflammatory, mucoadhesiveness, modified drug release capacity, and higher drug retention properties, could serve as a potential therapeutic alternative for treating dry eye conditions.

Smart theranostic contact lenses

Although smart contact lenses have demonstrated great potential in theranostics, there remain critical challenges and opportunities in their commercial development. In this Perspective, the current status and capability of smart theranostic contact lenses are highlighted, focusing on their application as sensing systems for detecting biomarkers such as glucose, intraocular pressure (IOP), and inflammatory cytokines, and as drug delivery systems (DDS) for precise and controlled therapy. Additionally, key challenges associated with clinical development and commercialization of smart theranostic contact lenses are discussed, to optimize diagnostic and therapeutic interventions. Considering the rapid evolution of the field, we finally also discuss the need for systematic studies on safety, efficacy, and mass-production, and we spark new ideas for advancing smart theranostic contact lenses into versatile platforms for personalized medicine.

Reversal of Diabetic Dry Eye by Topical Opioid Receptor Blockade Follows Dual Pathways

Purpose

To determine pathways in the trigeminal ganglion and corneal epithelium that are targeted by topical naltrexone (NTX) treatment for dry eye.

Methods

NTX drops were administered topically daily for 15 days to the corneal surface of male and female adult type 1 diabetic rats. Schirmer scores and corneal sensitivity were measured at baseline, 5, 10, and 15 days. Trigeminal ganglion and corneal epithelium were processed for immunohistochemistry to detect expression of opioid growth factor receptor (OGFr), Ki67, nerve growth factor, insulin-like growth factor-1, calcitonin gene-related peptide, substance P, and TNF-α. A proteomic study determined protein changes in the cornea.

Results

Corneal sensitivity and tear production in diabetic rats were restored to normal levels within 5 days after topical NTX. Assessment of corneal tissue after 15 days of treatment revealed that defects in OGFr expression, epithelial cell number, and Ki67+ expression were restored to normal by NTX. Inflammation markers (e.g., TNF-α) were reduced in tissue from diabetic rats treated with NTX. Proteomic data suggest diabetes causes dysregulation in inflammatory biological processes. The percentages of calcitonin gene-related peptide-positive neurons, but not substance P-positive neurons, in the trigeminal ganglion were increased after NTX treatment. Diabetic male and female rats responded to NTX in a comparable manner.

Conclusions

Type 1 diabetes results in decreased tear production and altered corneal surface sensitivity. These complications coincide with dysregulated OGFr that maintains ocular homeostasis. Reversal of dry eye and restoration of corneal sensitivity in diabetic male and female rats after 15 days of topical treatment with NTX occur following dual pathways of increased cellular proliferation and reduction of inflammation.

Association of ocular adverse events with varenicline solution use: a population-based study

BACKGROUND

Approved by the FDA in 2021, varenicline solution is the first nasal spray specifically designed to enhance basal tear film production for treating dry eye disease (DED). However, there is a lack of data comprehensively comparing its safety profile to conventional DED therapies. Herein, we assess whether ocular adverse events (AEs) are disproportionately reported with the real-world use of varenicline solution.

RESEARCH DESIGN AND METHODS

This observational, population-based pharmacovigilance study analyzed the Food and Drug Administration Adverse Event Reporting System (FAERS) data (inception-April 2024) using reporting odds ratio (ROR), with significance defined as a 95% CI lower bound > 1.0. Nasal saline and systane were the controls.

RESULTS

A total of 1,125 AE reports were associated with varenicline solution. No disproportionate reporting of specific ocular AEs was observed when comparing varenicline solution with nasal saline. However, when compared with systane, varenicline solution showed higher odds of lacrimation (ROR = 2.18, 95%CI = 1.46-3.26, p < 0.0001), visual impairment (ROR = 2.27, 95%CI = 1.24-4.16, p = 0.0085), and photophobia (ROR = 7.50, 95%CI = 3.68-15.27, p < 0.0001).

CONCLUSIONS

Although a direct causal relationship for higher RORs cannot be established for varenicline solution compared to systane, our findings provide evidence for potential risk signals and highlight the crucial role of post-marketing pharmacovigilance in monitoring long-term safety.

Adhesion Mechanism, Applications, and Challenges of Ocular Tissue Adhesives

Corneal injury is prevalent in ophthalmology, with mild cases impacting vision and severe cases potentially resulting in permanent blindness. In clinical practice, standard treatments for corneal injury involve transplantation surgery combined with pharmacological therapy. However, surgical sutures exhibit several limitations, which can be overcome using tissue adhesives. With recent advances in biomedical materials, the use of ophthalmic tissue adhesives has expanded beyond wound closure, including tissue filling and drug delivery. Furthermore, the use of tissue adhesives has demonstrated promising outcomes in drug delivery, ophthalmic disease diagnosis, and biological scaffolds. This study briefly introduces common adhesion mechanisms and their applications in ophthalmology, aiming to increase interest in tissue adhesives and clinical ophthalmic treatment.

How to Fabricate Hyaluronic Acid for Ocular Drug Delivery

This review aims to examine existing research on the development of ocular drug delivery devices utilizing hyaluronic acid (HA). Renowned for its exceptional biocompatibility, viscoelastic properties, and ability to enhance drug bioavailability, HA is a naturally occurring biopolymer. The review discussed specific mechanisms by which HA enhances drug delivery, including prolonging drug residence time on ocular surfaces, facilitating controlled drug release, and improving drug penetration through ocular tissues. By focusing on these unique functionalities, this review highlights the potential of HA-based systems to revolutionize ocular treatment. Various fabrication techniques for HA-based ocular drug delivery systems, including hydrogels, nanoparticles, and microneedles, are discussed, highlighting their respective advantages and limitations. Additionally, this review explores the clinical applications of HA-based devices in treating a range of ocular diseases, such as dry eye syndrome, glaucoma, retinal disorders, and ocular infections. By comparing the efficacy and safety profiles of these devices with traditional ocular drug delivery methods, this review aims to provide a comprehensive understanding of the potential benefits and challenges associated with HA-based systems. Moreover, this review discusses current limitations and future directions in the field, such as the need for standardized fabrication protocols, long-term biocompatibility studies, and large-scale clinical trials. The insights and advancements presented in this review aim to guide future research and development efforts, ultimately enhancing the effectiveness of ocular drug delivery and improving patient outcomes.

Rebuilding the autoimmune-damaged corneal stroma through topical lubrication

Corneal lubrication is the most common treatment for relieving the signs and symptoms of dry eye and is considered to be largely palliative with no regenerative functions. Here we challenge this notion by demonstrating that wetting the desiccated cornea of an aqueous-deficient mouse model with the simplest form of lubrication, a saline-based solution, is sufficient to rescue the severely disrupted collagen-rich architecture of the stroma, the largest corneal compartment that is essential to transparency and vision. At the single cell level we show that stromal keratocytes responsible for maintaining stromal integrity are converted from an inflammatory state into unique reparative cell states by lubrication alone, thus revealing the extensive plasticity of these cells and the regenerative function of lubricating the surface. We further show that the generation of a reparative phenotype is due, in part, to disruption of an IL1β autocrine amplification loop promoting chronic inflammation. Thus, our study uncovers the regenerative potential of topical lubrication in dry eye and represents a paradigm shift in our understanding of its therapeutic impact.

JAK1, SKI, ZBTB16 as potential biomarkers mediate the inflammatory response in keratoconjunctivitis sicca

Keratoconjunctivitis sicca (KCS) is an ocular condition characterized by insufficient tear production and inflammatory irritation, with Sjögren's syndrome (SS) being a major causative factor. This study aimed to extract patient transcriptomic data from the GEO database to identify signature genes associated with the diagnosis and treatment of KCS and the expression of three key genes were experimentally verified. We performed a difference analysis on the SS patient dataset and performed a Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis on the resulting genes. Additionally, a Weighted Gene Co-expression Network Analysis (WGCNA) was constructed. Machine learning techniques were employed to analyze the most strongly correlated gene modules with SS traits. These findings were further validated using KCS immune-correlation microarrays as a validation set. The correlation of the three identified genes with 22 immune cells was assessed through immune infiltration analysis. Subsequently, a rat model of desiccated keratoconjunctivitis was established, and the modeling situation and expression of characteristic genes were analyzed at the morphological, tissue, and molecular levels. Bioinformatic prediction revealed that the expression of JAK1, SKI, ZBTB16 not only differed in the machine learning validation set, but also correlated with some immune cells in the immune infiltration analysis. The results of animal experiments showed that the transcription and expression levels of these three genes were significantly different in rat KCS tissues and normal tissues, and there were also differences in the expression of JAK1 and SKI in rat peripheral blood, as well as significant up-regulation of the expression of related inflammatory factors in KCS tissues. Through bioinformatics prediction and animal experimental validation, this study identified three differentially expressed genes in SS mediated KCS patients, which provide new potential biological targets for the diagnosis and treatment of KCS.

Genomics of Staphylococcus aureus and Enterococcus faecalis isolated from the ocular surface of dry eye disease sufferers

Ocular surface inflammatory disorders, such as dry eye, are becoming increasingly prevalent. Developing new treatment strategies targeting harmful bacteria could provide significant therapeutic benefits. The purpose of this study was to characterize the common ocular pathogen Staphylococcus aureus and the rarer endophthalmitis-associated species Enterococcus faecalis isolated from the ocular surface of dry eye disease patients in Norway. Together the 7 isolates (5 S. aureus and 2 E. faecalis) comprise the complete set of members of each species isolated in our previous study of the ocular microbiome of 61 dry eye sufferers. We aimed to investigate the pathogenic potential of these isolates in relation to ocular surface health. To this end, we used whole genome sequencing, multiplex PCR directed at virulence genes and antibiotic susceptibility tests encompassing clinically relevant agents. The E. faecalis isolates showed resistance to only gentamicin. S. aureus isolates displayed susceptibility to most of the tested antibiotics, except for two isolates which showed resistance to trimethoprim/sulfamethoxazole and three isolates which were resistant to ampicillin. Susceptibilities included sensitivity to several first-line antibiotics for treatment of ocular infections by these species. Thus, treatment options would be available if required. However, spontaneous resistance development to gentamicin and rifampicin occurred in some S. aureus which could be a cause for concern. Whole genome sequencing of the isolates showed genome sizes ranging from 2.74 to 2.83 Mbp for S. aureus and 2.86 Mbp for E. faecalis, which is typical for these species. Multilocus sequence typing and phylogenetic comparisons with previously published genomes, did not suggest the presence of eye-specific clusters for either species. Genomic analysis indicated a high probability of pathogenicity among all isolates included in the study. Resistome analysis revealed the presence of the beta-lactamase blaZ gene in all S. aureus isolates and the dfrG gene in two of them; while E. faecalis isolates carried the lsa(A) gene which confers intrinsic resistance to lincosamides and streptogramin A in this species. Screening for virulence factors revealed the presence of various pathogenicity associated genes in both S. aureus and E. faecalis isolates. These included genes coding for toxin production and factors associated with evading the host immune system. Some of the identified genes (tst, hylA & hylB) are suggested to be linked to the pathophysiology of dry eye disease. Lastly, the presence of specific S. aureus virulence genes was confirmed through multiplex PCR analysis.

Multidimensional immunotherapy for dry eye disease: current status and future directions

Dry Eye Disease (DED) is a multifactorial condition driven by tear film hyperosmolarity, immune dysregulation, and neuro-immune interactions. The immune system plays a central role in its pathogenesis, influencing both inflammation and ocular surface damage. While traditional immunotherapies like anti-inflammatory agents and immunosuppressants offer symptom relief, their long-term use is limited by side effects. This review focuses on emerging immunotherapies, including biologics, stem cell therapy, gene therapy, nanotechnology, and exosome-based treatments, all of which hold promise in modulating immune responses and promoting tissue repair. The relationship between the ocular microbiome and DED is also explored, with an emphasis on personalized immunotherapy. Key challenges for future research include identifying novel therapeutic targets, optimizing clinical translation, and evaluating the long-term efficacy of these innovative treatments.

Advancements in Ocular Therapy: A Review of Emerging Drug Delivery Approaches and Pharmaceutical Technologies

Eye disorders affect a substantial portion of the global population, yet the availability of efficacious ophthalmic drug products remains limited. This can be partly ascribed to a number of factors: (1) inadequate understanding of physiological barriers, treatment strategies, drug and polymer properties, and delivery systems; (2) challenges in effectively delivering drugs to the anterior and posterior segments of the eye due to anatomical and physiological constraints; and (3) manufacturing and regulatory hurdles in ocular drug product development. The present review discusses innovative ocular delivery and treatments, encompassing implants, liposomes, nanoparticles, nanomicelles, microparticles, iontophoresis, in situ gels, contact lenses, microneedles, hydrogels, bispecific antibodies, and gene delivery strategies. Furthermore, this review also introduces advanced manufacturing technologies such as 3D printing and hot-melt extrusion (HME), aimed at improving bioavailability, reducing therapeutic dosages and side effects, facilitating the design of personalized ophthalmic dosage forms, as well as enhancing patient compliance. This comprehensive review lastly offers insights into digital healthcare, market trends, and industry and regulatory perspectives pertaining to ocular product development.

Tear meniscus height comparison between AS-OCT and Oculus Keratograph® K5M

Objectives

To evaluate the agreement between Spectral-Domain Optical Coherence Tomography (AS-OCT) and Oculus Keratograph® 5M in measuring tear meniscus height (TMH) and to assess the impact of contact lens wear on these measurements. Materials and methods: TMH was measured in 54 healthy eyes using AS-OCT (3D OCT-1 Maestro, Topcon, Tokyo, Japan) and Oculus Keratograph® 5M (OCULUS Optikgeräte, Wetzlar, Germany), with and without contact lens wear. Bland-Altman analysis was used to assess agreement between the two devices. Delefilcon A, water-gradient, daily disposable contact lenses were used, and measurements were carried out after a 20-minute adaptation period.

Results

The means of TMH without the contact lenses were 0.21 ± 0.06 mm and 0.20 ± 0.05 mm obtained from AS-OCT and Oculus K5M, respectively, and these measurements were not statistically significant (t (53) = 0.99, p = 0.33). No significant differences were observed in TMH compared to contact lenses (t (53) = 1.52, p = 0.13). Agreement between measurements obtained by both the instruments was assessed using Bland-Altman analysis. The limits of agreement were within clinically acceptable ranges (0.10 mm - 0.15 mm), with no evidence of significant bias (t = -0.32, r = 0.22). The results obtained with contact lenses were also not statistically significant (t (53) = 1.52, p < 0.05).

Discussion

The present study compared tear meniscus height (TMH) measurements obtained from AS-OCT and Oculus K5M in subjects with and without contact lens wear. Both instruments showed good agreement, with AS-OCT consistently measuring slightly higher TMH values than Oculus K5M. The mean TMH values were similar to those of previous studies, indicating normal tear film in the subjects. Contact lens wear was found to reduce TMH slightly, but it returned to baseline after a short adaptation period. The Bland-Altman analysis confirmed good agreement between the two instruments, with most data points falling within the limits of agreement. These findings suggest that AS-OCT and Oculus K5M can be reliable tools for measuring TMH and can be used interchangeably for clinical practice.

Conclusion

AS-OCT and Oculus Keratograph® 5M showed comparable results in measuring TMH, suggesting potential interchangeability in clinical practice. Further validation in broader clinical settings and diverse subject groups may be warranted.

An Update on the Nitrogen Heterocycle Compositions and Properties of U.S. FDA-Approved Pharmaceuticals (2013-2023)

This Perspective is a continuation of our analysis of U.S. FDA-approved small-molecule drugs (1938-2012) containing nitrogen heterocycles. In this study we report drug structure and property analyses of 321 unique new small-molecule drugs approved from January 2013 to December 2023 as well as information about frequency of important heteroatoms such as sulfur and fluorine and key small nitrogen substituents (CN and NO2). The most notable change is an incredible increase in drugs containing at least one nitrogen heterocycle─82%, compared to 59% from preceding decades─as well as a significant increase in the number of nitrogen heterocycles per drug. Pyridine has claimed the #1 high-frequency nitrogen heterocycle occurrence spot from piperidine (#2), with pyrimidine (#5), pyrazole (#6), and morpholine (#9) being the big top 10 climbers. Also notable is high number of fused nitrogen heterocycles, apparently driven largely by newly approved cancer drugs.

Multifunctional Cerium Oxide Nanozyme for Synergistic Dry Eye Disease Therapy

Dry eye disease (DED) is a chronic multifactorial ocular surface disease mainly caused by the instability of tear film, characterized by a series of ocular discomforts and even visual disorders. Oxidative stress has been recognized as an upstream factor in DED development. Diquafosol sodium (DQS) is an agonist of the P2Y2 receptor to restore the integrity/stability of the tear film. With the ability to alternate between Ce3+ and Ce4+, cerium oxide nanozymes could scavenge overexpressed reactive oxygen species (ROS). Hence, a DQS-loaded cerium oxide nanozyme was designed to boost the synergistic treatment of DED. Cerium oxide with branched polyethylenimine-graft-poly(ethylene glycol) as nucleating agent and dispersant was fabricated followed with DQS immobilization via a dynamic phenylborate ester bond, obtaining the DQS-loaded cerium oxide nanozyme (defined as Ce@PBD). Because of the ability to mimic the cascade processes of superoxide dismutase and catalase, Ce@PBD could scavenge excessive accumulated ROS, showing strong antioxidant and anti-inflammatory properties. Meanwhile, the P2Y2 receptors in the conjunctival cells could be stimulated by DQS in Ce@PBD, which can relieve the incompleteness and instability of the tear film. The animal experiments demonstrated that Ce@PBD significantly restored the defect of the corneal epithelium and increased the number of goblet cells, with the promotion of tear secretion, which was the best among commercial DQS ophthalmic solutions.

Smart Contact Lenses in Ophthalmology: Innovations, Applications, and Future Prospects

Smart contact lenses represent a breakthrough in the intersection of medical science and innovative technology, offering transformative potential in ophthalmology. This review article delves into the technological underpinnings of smart contact lenses, emphasizing the current landscape and advancements in biosensors, power supply, biomaterials, and the transmission of ocular information. This review further applies new innovations to their emerging role in the diagnosis, monitoring, and management of various ocular conditions. Moreover, we explore the impact of technical innovations on the application of smart contact lenses in monitoring glaucoma, managing postoperative care, and dry eye syndrome, further elucidating the non-invasive nature of these devices in continuous ocular health monitoring. The therapeutic potential of smart contact lenses such as treatment through targeted drug delivery and the monitoring of inflammatory biomarkers is also highlighted. Despite promising advancements, the implementation of smart contact lenses faces technical, regulatory, and patient compliance challenges. This review synthesizes the recent advances to provide an outlook on the state of smart contact lens technology. Furthermore, we discuss future directions, focusing on potential technological enhancements and new applications within ophthalmology.

Novel treatments for dry eye syndrome

Dry eye syndrome (DES) is a prevalent and multifactorial disease that leads to a self-perpetuating cycle of inflammation and damage to the ocular surface. This results in symptoms such as redness, burning, and blurred vision, which can negatively affect a patient's quality of life. While treatments are available to manage DES, they only temporarily relieve symptoms. Furthermore, long-term use of certain medications can cause harm to the ocular surface. Therefore, there is a need for safer and effective treatments for DES. This review highlights the latest advancements in DES therapy, providing valuable insights into ongoing efforts to improve patient outcomes.

How does ocular graft-versus-host disease fit under the dry eye umbrella? A review

Graft-versus-host disease (GVHD) is a systemic disease that can affect multiple organs as a consequence of an allogeneic haematopoietic stem cell transplant. One organ system that is often affected in GVHD is the eyes. Ocular GVHD (oGVHD) may involve various structures within the eye including the lacrimal glands, eyelids, conjunctiva, cornea, and nasolacrimal ducts, and is a source of morbidity in patients with GVHD. Common presenting features of GVHD overlap with dry eye disease (DED), including decreased tear production, epithelial disruption, and Meibomian gland dysfunction (MGD). In this review, we aim to compare oGVHD and DED to better understand the similarities and differences between the conditions, with a focus on pathophysiology, risk factors, clinical features, and treatments.

Current Advances in Regenerative Strategies for Dry Eye Diseases: A Comprehensive Review

Dry eye disease (DED) is an emerging health issue affecting millions of individuals annually. Ocular surface disorders, such as DED, are characterized by inflammation triggered by various factors. This condition can lead to tear deficiencies, resulting in the desiccation of the ocular surface, corneal ulceration/perforation, increased susceptibility to infections, and a higher risk of severe visual impairment and blindness. Currently, the clinical management of DED primarily relies on supportive and palliative measures, including the frequent and lifelong use of different lubricating agents. While some advancements like punctal plugs, non-steroidal anti-inflammatory drugs, and salivary gland autografts have been attempted, they have shown limited effectiveness. Recently, there have been promising developments in the treatment of DED, including biomaterials such as nano-systems, hydrogels, and contact lenses for drug delivery, cell-based therapies, biological approaches, and tissue-based regenerative therapy. This article specifically explores the different strategies reported so far for treating DED. The aim is to discuss their potential as long-term cures for DED while also considering the factors that limit their feasibility and effectiveness. These advancements offer hope for more effective and sustainable treatment options in the future.

Slug-Flow Microextraction Mass Spectrometry for Enhanced Detection of Analytes in Human Tear Fluids using Noninvasive Microsampling and Nanoelectrospray Ionization via a Capillary

In vivo noninvasive sampling and sensitive analysis of human tear fluids at the microliter level is an important but challenging task in investigating eye health. In this work, capillary microsampling coupled with slug-flow microextraction mass spectrometry (SFME-MS) was developed for enhanced detection of analytes in human tear fluids. As low as 1.0 μL of human tear fluid could be directly sampled using a capillary, and extraction/spray solvent was then loaded into the capillary to perform slug-flow microextraction and direct nanoelectrospray ionization (nESI) of analytes. All analytical procedures, including tear microsampling, microextraction, and ionization of analytes, were performed using a capillary. Enhanced detection of therapeutic drugs and disease biomarkers in human tear fluids was successfully demonstrated. Acceptable analytical performances including sensitivity, reproducibility, and quantitation were obtained. It is found that the use of SFME could improve the nESI-MS detection of trace analytes over 100-fold that depends on the chemical properties of analytes. Overall, this study showed that SFME-nESI-MS is a highly effective method for enhanced detection of trace analytes in tear fluids and is expected to be a potentially powerful tool in significant biological and clinical applications.