Redefining Dry Eye Disease Management: Emerging Pharmacologic and Device-Based Therapies in the Era of Precision Care: A Narrative Review

Dry eye disease (DED) is a common, chronic ocular condition marked by tear film instability and surface inflammation that impairs comfort, vision, and overall quality of life. In the last decade, major advances have reshaped therapeutic strategies across four domains: novel pharmacological agents, device-based treatments, patient stratification, and long-term care models. New pharmacotherapies include next-generation anti-inflammatory drugs such as lifitegrast and improved cyclosporine formulations, along with short-term corticosteroid suspensions for acute flares. Secretagogues and biologics have broadened treatment options. Nasal varenicline spray is now approved to stimulate endogenous tear production through neurostimulation, while perfluorohexyloctane is the first topical therapy targeting evaporative DED, which acts by reducing excessive tear evaporation. Regenerative approaches, including autologous serum and platelet-rich plasma eye drops, are increasingly used in severe cases to deliver growth factors that support epithelial healing. Device-based therapies have also advanced significantly. Thermal pulsation platforms (LipiFlow, iLux, TearCare) apply controlled heat and pressure to meibomian glands to relieve obstruction more effectively than standard warm compresses. Adjunctive technologies, such as intense pulsed light (IPL), improve tear film stability and reduce inflammation in refractory meibomian gland dysfunction. Neurostimulator devices, both intranasal and external, enhance tear secretion through targeted trigeminal pathway activation. Sustained-release drug delivery systems, including investigational punctal inserts, aim to improve adherence and long-term treatment consistency. Given DED's heterogeneity, personalized and phenotype-driven management is becoming central to clinical practice. Point-of-care diagnostics, including tear osmolarity testing, matrix metalloproteinase-9 (MMP-9) inflammatory marker assays, and meibography, allow more precise classification of aqueous-deficient, evaporative, or mixed disease, enabling tailored therapy selection. Long-term management increasingly follows a chronic-disease model emphasizing maintenance therapy, environmental modifications, digital health tools for symptom tracking, and proactive patient education to enhance adherence. By integrating innovative treatments with individualized management strategies, clinicians are now better equipped to disrupt the cycle of inflammation and tear film instability, ultimately improving outcomes for patients with dry eye disease.