Gabapentin for Ocular Surface Disorders: Bridging Molecular Mechanisms to Therapeutic Innovation

This commentary critically evaluates Rusciano's (2024) comprehensive review on gabapentin (GBP) as a multifaceted therapy for ocular surface diseases, emphasizing its transition from systemic to topical applications. We highlight the review's synthesis of GBP's polypharmacology—spanning calcium channel modulation, anti-inflammatory effects, and neuroprotection—and its innovative integration with nanotechnology (e.g., nanoceria platforms) to overcome corneal delivery challenges while potentially reducing systemic side effects associated with oral administration. While applauding its mechanistic depth and translational vision, we identify key gaps: the pressing need for rigorous evaluation of long-term topical safety, the imperative for clinical trials to validate novel formulations, and unresolved questions about GBP's comparative efficacy versus biologics (e.g., neurotrophic factors) and pregabalin. Positioned within a competitive landscape of emerging ocular therapies, Rusciano's work serves as both a milestone in GBP research and a catalyst for future studies to optimize its role in personalized ophthalmic therapeutics, contingent upon robust clinical and safety data for topical use.