Experts Perspectives on Current Practices and Challenges of Diagnosis and Treatment of Dry Eye Disease across Europe and Central Asia

INTRODUCTION: Dry eye disease (DED) is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles. Affecting up to 60% of individuals worldwide, DED imposes a significant physical, psychosocial, and economic burden. Its diagnosis remains challenging owing to heterogeneous clinical presentations, poor correlation between signs and symptoms, and limited access to advanced diagnostic tools. This study aimed at exploring real-world clinical practices in the diagnosis and management of DED across Europe and Central Asia by gathering experts' perspectives. METHODS: A panel of experts comprising 15 specialists from tertiary referral centers across 10 countries convened to discuss diagnostic workflows and treatment strategies for DED. RESULTS: The consensus emphasized that symptom questionnaires, slit-lamp examination, tear break-up time, and corneal and conjunctival staining represent the cornerstone of diagnosis. Tear osmolarity testing was used less frequently, primarily owing to cost and limited resource availability. Most cases managed in specialized centers were moderate-to-severe, underscoring the need for comprehensive and multidisciplinary evaluation. Treatment practices emphasized a stepwise approach, with first-line therapy comprising conventional measures such as environmental and behavioral modifications, tear substitutes, and lid hygiene. Cyclosporine A (CsA) eye drops were reserved for patients with an insufficient response to first-line therapy or with clinically significant ocular surface inflammation. In these cases, experts indicated that concomitant short-term glucocorticosteroids with CsA may be used initially, followed by CsA monotherapy for long-term disease control. Regular follow-up and patient education were considered essential to support treatment adherence and efficacy. Interdisciplinary collaboration, particularly with rheumatologists and mental health professionals, was regarded as critical for managing systemic comorbidities and addressing psychosocial impacts. CONCLUSIONS: This consensus highlights the value of sharing experts' experience to harmonize care standards and optimize clinical outcomes. Early recognition of ocular surface inflammation, timely initiation of immunomodulatory therapy, and integrated multidisciplinary care are essential for improving patient quality of life across diverse healthcare settings.