Integrating secretagogues into clinical dry eye care: Insights from Asian clinical experience

Dry eye is a multifactorial condition characterized by tear film instability, leading to visual disturbances and discomfort. In Asia, clinical management often follows a tear film-oriented approach that emphasizes restoring specific tear components, particularly through the use of secretagogues such as diquafosol and rebamipide. These agents promote aqueous and/or mucin secretion and have been widely adopted in Japan and other Asian countries as frontline therapies for various tear film deficiencies. This review outlines the clinical rationale for secretagogue use and summarizes real-world applications across different settings, including general outpatient care, perioperative management for cataract surgery, and contact lens-related ocular surface disorders. Tear Film-Oriented Diagnosis - a framework for classifying dry eye subtypes based on tear breakup patterns and identifying deficiencies in aqueous, lipid, or mucin components - is presented as a practical guide for treatment selection. Evidence from clinical trials and long-term observational studies supports the safety and efficacy of diquafosol and rebamipide in improving tear stability, reducing epithelial damage, and enhancing patient satisfaction. By highlighting regional practice patterns and accumulated clinical experience, this article offers perspectives on effectively integrating secretagogues into dry eye management. These insights may contribute to a broader understanding of individualized, mechanism-based treatment strategies beyond inflammation suppression.