Developments in the therapeutic landscape for dry eye

INTRODUCTION: Dry eye disease (DED) is a chronic condition that can markedly impair visual function and quality of life. While tear substitutes remain the conventional first-line therapy, expanding knowledge of DED has opened the door to treatments designed to act on distinct pathogenic mechanisms. AREAS COVERED: An extensive literature review using PubMed, Scopus, and Web of Science was conducted to evaluate both established and emerging therapies for DED. This review encompasses conventional tear substitutes and their properties, immune-modulating agents, blood derived products and other biological agents, tear-conservation approaches, device-based interventions, and recently approved as well as investigational treatment options. EXPERT OPINION: The evolving understanding of DED supports a shift toward mechanism-based, personalized management that addresses inflammation, tear film instability, neurosensory dysfunction, and glandular insufficiency. Integrating targeted therapies, device-based interventions, and regenerative approaches with improved diagnostics may enable more predictable, proactive care. Rigorous research is still needed to optimize treatment selection and sequencing.