The Role of Viral Infection and Microbial Dysbiosis in Glaucoma: From Pathogenesis to Therapeutic Strategies

Glaucoma is a leading cause of irreversible blindness, yet vision loss often progresses despite effective intraocular pressure (IOP) control, suggesting the involvement of non-hydrodynamic mechanisms. This review explores the potential synergistic interaction between viral persistence and microbial dysbiosis in pathogenesis. While acknowledging that current evidence regarding the microbiome is largely associative and derived from small cohorts or animal models, we analyze how these environmental insults may disrupt autophagic flux and induce immune dysregulation to drive chronic neuroinflammation. Furthermore, we explore theoretical therapeutic strategies targeting this distinct pathological nexus, ranging from metabolic restoration of the gut-eye axis to the repurposing of advanced nanocarriers to overcome ocular barriers. This framework lays the groundwork for next-generation, etiology-based precision management.