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A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: closed (30 September 2025) | Viewed by 18235

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Special Issue Editor

Dr. Liat Gantz

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Guest Editor

Department of Optometry and Vision Science, Hadassah Academic College, Jerusalem, Israel
Interests: anterior segment; contact lenses; complications in contact lenses; dry eye; MGD; digital eye strain; demodex; blepharitis

Special Issue Information

Dear Colleagues,

This Special Issue aims to explore the latest advancements in our understanding of the pathophysiology of dry eye, including risk and protective factors, and possible therapeutic solutions. We invite submissions that cover a broad range of topics, including but not limited to the biochemical changes in tear film composition, innovative diagnostic techniques, and novel therapeutic interventions.

Our goal is to compile a collection of high-quality research articles, reviews, and brief reports that not only deepen our understanding of these conditions but also contribute to the development of effective strategies for prevention, diagnosis, and treatment. We encourage contributions from researchers whose work helps bridge the gap between basic science and clinical practice in the study of dry eye.

We look forward to your submissions, advancing our knowledge of these increasingly prevalent conditions, which have significant implications for ocular and general health worldwide.

Warm regards,

Dr. Liat Gantz
Guest Editor

Dr. Reut Ifrah
Guest Editor Assistant
Department of Optometry and Vision Science
Jerusalem Multidisciplinary College, Jerusalem, Israel 91010001
Email: reutif@edu.jmc.ac.il
Website: https://www.jmc.ac.il/en/about/contact-list/reut-ifrah/
Interests: dry eye and ocular surface disease

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Keywords

dry eye
meibomian gland dysfunction
ocular surface disease

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Published Papers (10 papers)

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Editorial

Jump to: Research, Other

4 pages, 142 KB

Open AccessEditorial

Dry Eye Disease: Bridging Systemic Inflammation, Ocular Surface Biology, and Clinical Innovation

by Liat Gantz

Biomedicines 2026, 14(3), 684; https://doi.org/10.3390/biomedicines14030684 - 17 Mar 2026

Viewed by 754

Abstract

Dry eye disease (DED) is a prevalent and complex disease of the ocular surface [...] Full article

(This article belongs to the Special Issue Recent Research on Dry Eye)

Research

Jump to: Editorial, Other

11 pages, 255 KB

Open AccessArticle

Prevalence of Meibomian Gland Dysfunction in Patients with Keratoconus in an Optometry Clinic in the Palestinian Authority

by Reut Ifrah and Taqwa Darwish

Biomedicines 2026, 14(1), 134; https://doi.org/10.3390/biomedicines14010134 - 9 Jan 2026

Cited by 2 | Viewed by 934

Abstract

Background/Objectives: Meibomian gland dysfunction (MGD) has been shown to be more prevalent in patients with keratoconus (KC) in Turkey, Egypt, and Israel but has not been examined in the Palestinian Authority (PA). Therefore, this study compared the prevalence and clinical features of MGD in patients with keratoconus versus healthy controls seen in an optometry clinic in the PA. Methods: Patients with KC and healthy controls who were non-contact lens wearers were recruited. Habitual visual acuity (VA), tear break-up time (TBUT), meibography, meibomian gland (MG) expressibility (MES) and quality score (MQS), and Schirmer test were evaluated. MGD was defined by an Ocular Surface Disease Index (OSDI) Questionnaire score ≥ 13, TBUT < 10 s, and MG loss > Grade 1. Outcomes were compared using Mann–Whitney U tests, Chi-Square tests and Spearman correlation. Results: The study included 33 eyes of 17 KC (mean age: 29.2 ± 7.7, range:19–50) and 27 right eyes of 27 control participants (mean age: 34.2 ± 11.7, range:18–56). MGD was prevalent in 67% of KC and 30% of control participants. VA was significantly worse (0.8 + 0.2 vs. 1.0 + 0.0, p < 0.001), with significantly greater MG loss in the lower eyelids (p = 0.002), and shorter TBUT (4.1 ± 1.5 s vs. 5.7 ± 1.7 s, p < 0.001) in the KC group. No significant differences were found in symptoms, MES, MQS, MG loss in the upper eyelids, or Schirmer test. Conclusions: KC patients exhibited a significantly higher prevalence and severity of MGD signs compared with controls. These findings highlight the importance of comprehensive ocular surface evaluation and management in this population. Full article

(This article belongs to the Special Issue Recent Research on Dry Eye)

10 pages, 214 KB

Open AccessArticle

Association Between Sleep Apnea and Dry Eye Disease in the All-of-Us Program

by Annie Zhang, Jocelyn He and Gui-Shuang Ying

Biomedicines 2026, 14(1), 24; https://doi.org/10.3390/biomedicines14010024 - 22 Dec 2025

Cited by 1 | Viewed by 1060

Abstract

Purpose: The aim of this study was to investigate the association between obstructive sleep apnea (OSA) and the prevalence of dry eye disease (DED) and meibomian gland dysfunction (MGD) using the All-of-Us Research Program (AoURP) dataset from a large, demographically diverse U.S. population. Methods: In this cross-sectional, matched case–control study, participants with documented OSA were exactly matched 1:3 by age, gender, race, and ethnicity to controls without OSA. Associations between OSA and DED and MGD were evaluated using univariate and multivariate logistic regression models adjusted for obesity, diabetes, smoking, hypertension, hyperlipidemia, hypothyroidism, and cardiovascular disease at the time of enrollment. Results: Among the 628,649 AoURP participants, 59,804 individuals had OSA and 179,412 matched controls were identified with the same demographics (mean age 61.95 years; 54.0% female; 12.5% Hispanic; 62.3% non-Hispanic White; 15.5% non-Hispanic Black). Compared to controls, OSA participants had significantly higher rates of smoking (13.7% vs. 10.9%), obesity (68.4% vs. 13.2%), diabetes (43.3% vs. 11.7%), hypertension (76.4% vs. 28.2%), hyperlipidemia (74.5% vs. 27.5%), hypothyroidism (24.7% vs. 8.1%), and cardiovascular disease (43.1% vs. 12.8%) (all p < 0.001). Compared to matched controls, the prevalence of DED was significantly higher in the OSA group (19.4% vs. 5.8%), with an adjusted odds ratio (OR) of 1.76 (95% confidence interval (95% CI), 1.70–1.82; p < 0.001). MGD prevalence was also higher in the OSA group (2.6% vs. 1.0%), with an adjusted OR of 1.43 (95% CI, 1.32–1.55; p < 0.001). Conclusions: In this large, demographically diverse U.S. population, obstructive sleep apnea was independently associated with a higher prevalence of both dry eye disease and meibomian gland dysfunction. These findings provide large-scale U.S. evidence and suggest that screening for ocular surface disease may be warranted in patients with OSA to improve detection and management. Full article

(This article belongs to the Special Issue Recent Research on Dry Eye)

12 pages, 393 KB

Open AccessArticle

Impact of Positive Airway Pressure and Mask Leakage on Dry Eye and Glaucoma Risk in Obstructive Sleep Apnea: A Cross-Sectional Analysis

by Wei-Xiang Wang, Ya-Ning Chuang, Chen-Ni Chang, Mei-Chen Yang and Elizabeth P. Shen

Biomedicines 2025, 13(12), 3077; https://doi.org/10.3390/biomedicines13123077 - 13 Dec 2025

Cited by 1 | Viewed by 1307

Abstract

Purpose: This study investigates the association between obstructive sleep apnea (OSA), dry eye disease (DED), and glaucoma, focusing on the impact of positive airway pressure (PAP) usage and air leakage. Methods: This retrospective cross-sectional study included 57 adults with polysomnography-confirmed OSA between 2010 and 2023. Participants were grouped into PAP users (PAP+, n = 40) and non-users (PAP−, n = 17). Ocular assessments included tear film break-up time, Schirmer’s test, Oxford staining, meibomian gland evaluation, intraocular pressure, cup-to-disc (C/D) ratio, and retinal nerve fiber layer thickness. PAP device data (usage duration and air leak rate) and OSA severity metrics were recorded. Group comparisons used chi-square and Student’s t-test, and regression analyses identified associations between PAP leakage and ocular parameters. Results: Among the 57 OSA patients, PAP users showed a trend toward a higher risk of glaucoma (OR = 0.83) and DED (OR = 0.69) compared to non-users, but neither trend was statistically significant. PAP users had significantly more severe OSA, including longer N1 sleep stage (p = 0.0005), higher apnea-hypopnea index (AHI, p = 0.0001), and poorer oxygenation. PAP leakage: 95% (mean = 25.84 L/min) exceeded the 24 L/min threshold specified in ResMed’s clinical guidelines, suggesting suboptimal therapy. Higher PAP leak was significantly associated with a lower Schirmer’s test value (p = 0.031) and a higher C/D ratio (p = 0.040) on regression analysis. However, no significant differences were found in ophthalmic parameters between PAP+ and PAP− groups. Conclusions: Suboptimal PAP therapy as mask leakage or nocturnal hemodynamic changes may worsen evaporative dry eye and affect intraocular pressure. Our findings highlight the association between PAP mask leakage and reduced tear production, and suggest that OSA-related optic nerve stress may persist unless both hypoxia and nocturnal IOP fluctuations are properly managed. However, due to the relatively small sample size and retrospective cross-sectional design, future prospective studies with larger cohorts are needed to confirm these associations. Full article

(This article belongs to the Special Issue Recent Research on Dry Eye)

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14 pages, 986 KB

Open AccessArticle

A Randomised Pilot Trial to Demonstrate the Feasibility of a Prototype Electronic Heating Device in Patients with Meibomian Gland Dysfunction

by Jacqueline Tan, Tianni Jia, Sidra Qamar, Jennie Diec and Fiona Stapleton

Biomedicines 2025, 13(12), 2952; https://doi.org/10.3390/biomedicines13122952 - 30 Nov 2025

Viewed by 1578

Abstract

Objectives: To compare the safety and efficacy of a prototype electronic heating device, Meiboleyes^®, with the BRUDER Moist Heat Eye Compress for the treatment of Meibomian Gland Dysfunction (MGD). Methods: Adults with evidence of active MGD (Ocular Surface Disease Index [OSDI] score ≥ 13, fluorescein tear break-up time [TBUT] < 10 s and meibomian gland secretion score ≤ 12 for 15 glands of the lower lid) were enrolled in this prospective, randomised, parallel group, investigator-masked dispensing study (Australian New Zealand Clinical Trials Registry–ACTRN12624000175572). Meibomian gland secretion (MGS) score and number of meibomian glands yielding liquid secretion (MGYLS), lipid layer thickness, TBUT, ocular physiology and subjective symptoms were measured at baseline, and 2 weeks and 6 weeks following treatment. Linear mixed model analysis was conducted to compare the two groups and changes over time. Results: Ten participants (average age 38.7 ± 14.5 years) in the Meiboleyes^® test group, and 10 participants (average age 38.9 ± 14.8 years) in the BRUDER control group completed the study. MGS and MGYLS significantly improved in both treatment groups from baseline to the 2-week and 6-week follow-up visits (p ≤ 0.006). Significant improvements in TBUT (5.5 ± 1.8 vs. 8.3 ± 2.1 s, p = 0.044), OSDI scores (45.2 ± 15.1 vs. 27.4 ± 12.9, p = 0.027) and visual analogue scale dryness (55.3 ± 27.2 vs. 28.0 ± 23.9, p = 0.023) were observed in the Meiboleyes^® group only after 6 weeks of treatment. No other significant differences were observed over time or between groups. Eight treatment-related adverse events were reported in the Meiboleyes^® group compared to seven in the BRUDER group. All resolved without sequalae. Conclusions: The prototype Meiboleyes^® device was safe and effective for use as an at-home treatment for MGD when used twice daily for six weeks. Improvements in meibomian gland function were comparable to the BRUDER Moist Heat Eye Compress, but significant improvements in tear film stability and subjective comfort after 6 weeks of treatment were observed in the Meiboleyes^® group only. Full article

(This article belongs to the Special Issue Recent Research on Dry Eye)

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14 pages, 930 KB

Open AccessArticle

The Relationship Between Composite Inflammatory Indices and Dry Eye in Hashimoto’s Disease-Induced Hypothyroid Patients

by Asli Kirmaci Kabakci, Derya Cepni Cakir and Arzu Taskiran Comez

Biomedicines 2025, 13(11), 2675; https://doi.org/10.3390/biomedicines13112675 - 30 Oct 2025

Cited by 1 | Viewed by 1154

Abstract

Background/Objectives: Hashimoto’s thyroiditis-induced hypothyroidism (HT–HypoT) is frequently accompanied by ocular surface complaints, but the role of systemic inflammatory markers in dry eye disease (DED) among these patients remains unclear. This study aimed to evaluate the relationship between composite inflammatory indices and the presence and severity of DED in patients with HT–HypoT. Methods: This retrospective study included 86 HT–HypoT patients and 43 DED controls without systemic comorbidities. DED diagnosis and severity were assessed using the Ocular Surface Disease Index (OSDI) and objective ocular surface tests. Laboratory parameters and composite inflammatory indices—including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), C-reactive protein-to-albumin ratio (CAR), and prognostic nutritional index (PNI)—were compared between groups. Results: DED was present in 44% of HT–HypoT patients. SIRI and CAR were higher in HT–HypoT patients with DED and increased with severity. Both indices independently predicted the presence and severity of DED and exhibited higher diagnostic performance than other inflammatory indices. Conclusions: In patients with HT–HypoT, SIRI and CAR provide additional diagnostic value for identifying the presence and severity of DED beyond that offered by traditional markers. These findings highlight the potential utility of routine blood-derived indices as adjunctive biomarkers in thyroid-related DED. Full article

(This article belongs to the Special Issue Recent Research on Dry Eye)

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13 pages, 2021 KB

Open AccessArticle

The Impact of Dry Eye Disease on Corneal Biomechanics Analyzed with Corneal Visualization Scheimpflug Technology

by Li-Wen Chiu, Ren-Wen Ho, Hun-Ju Yu, Po-Chiung Fang, I-Hui Yang and Ming-Tse Kuo

Biomedicines 2025, 13(10), 2524; https://doi.org/10.3390/biomedicines13102524 - 16 Oct 2025

Cited by 1 | Viewed by 1276

Abstract

Background/Objectives: Dry eye disease (DED) is an ocular surface disease with unstable tear film hemeostasis that could influence the corneal biomechanics. The study aimed to elucidate the impact of dry eye severity on corneal biomechanics. Methods: This is a prospective cohort study that enrolled 72 participants with or without dry eye severity. All subjects received dry eye and corneal biomechanic assessment. Dry eye patients were divided into non-DED (>6 s) and DED (<6 s) groups based on the average non-invasive keratograph tear break-up time to compare their performance in corneal biomechanics. We further analyzed the correlation between the corneal biomechanic parameters and dry eye indexes for these patients. Results: In this study, 38 non-DED patients and 34 DED patients were enrolled for analysis. The two groups showed significant differences in first applanation (A1) deflection area (p = 0.002), A1 delta arc length (p = 0.024), second applanation (A2) deformation amplitude (p = 0.024), and whole eye movement [mm] (p = 0.021). Moreover, both A1 deflection area and A1 delta arc length revealed significantly correlated with tear meniscus height in DED patients. Conclusions: DED and its severity can affect corneal biomechanics. Tear volume on the ocular surface could be one of the important factors to influence corneal biomechanics. Full article

(This article belongs to the Special Issue Recent Research on Dry Eye)

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14 pages, 379 KB

Open AccessArticle

Functional and Emotional Impact of Dry Eye and Meibomian Gland Dysfunction in Keratoconus

by Liat Gantz, Avi Besser, Rivki Bloom and Reut Ifrah

Biomedicines 2025, 13(8), 1918; https://doi.org/10.3390/biomedicines13081918 - 6 Aug 2025

Cited by 2 | Viewed by 3316

Abstract

Background/Objectives: Dry eye (DE) can cause persistent eye rubbing, contributing to keratoconus (KC) development and progression. Both keratoconus (KC) and dry eye (DE) significantly impact patients’ functional and emotional well-being, with KC patients exhibiting a higher prevalence of DE symptoms and signs. This study examined whether functional (KEPAQ-F) and emotional (KEPAQ-E) quality of life, assessed by the Keratoconus End-Points Assessment Questionnaire, differ when influenced by symptoms and clinical signs of general DE versus meibomian gland dysfunction (MGD) in KC patients. Methods: Volunteers with KC (ages 18–70) underwent DE and MGD assessments, completing OSDI, MGD (MGDQ), and KEPAQ questionnaires. Clinical measures included NITBUT, Schirmer, and meibography. Pearson correlations and path analysis assessed relationships between DE and MGD symptoms and KEPAQ-F/E. Results: Forty-five KC participants (mean age: 45 ± 13, range: 20–69 years, 25 males) were enrolled; 22 (49%) had DE, and 15 (33%) had MGD. Significant correlations were observed between KEPAQ-E (2.9 ± 3.0 Logit) and KEPAQ-F (1.7 ± 3.0 Logit) scores with OSDI (26.5 ± 26.7) and MGDQ (3.3 ± 2.2) scores, and all Belin outcome measures A-D for all participants. In participants with diagnosed dry eye, KEPAQ E and F were also significantly correlated with loss of meibomian glands in the lower eyelids (R = −0.44, p = 0.04). Path analysis showed both DE and MGD were negatively correlated with lower KEPAQ-E and KEPAQ-F scores, with DE symptoms more influential (p < 0.05). The model explained 42% of the KEPAQ-E variance and 41% of the KEPAQ-F variance. Conclusions: Emotional and functional quality of life in KC is significantly and negatively related to DE and MGD symptoms, with DE symptoms exhibiting a greater impact. Furthermore, greater loss of meibomian glands in the lower eyelids is significantly associated with reduced emotional and functional KEPAQ scores in DE patients. These results underscore the critical importance of evaluating DE in KC to improve patient-reported outcomes. Full article

(This article belongs to the Special Issue Recent Research on Dry Eye)

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16 pages, 3287 KB

Open AccessArticle

Evaluating Magnetic Stimulation as an Innovative Approach for Treating Dry Eye Disease: An Initial Safety and Efficacy Study

by Hadas Ben-Eli, Shimon Perelman, Denise Wajnsztajn and Abraham Solomon

Biomedicines 2025, 13(5), 1064; https://doi.org/10.3390/biomedicines13051064 - 28 Apr 2025

Cited by 2 | Viewed by 2336

Abstract

Objective: The aim of this study was to assess the safety and preliminary efficacy of repetitive magnetic stimulation (RMS) as a treatment intervention for dry eye disease (DED), focusing on symptom reduction. Methodology: This investigation involved 22 adult participants (85% females, aged between 22 and 79 years) diagnosed with moderate-to-severe DED. These individuals were subjected to RMS treatment targeting one or both eyes using the VIVEYE-Ocular Magnetic Neurostimulation System version 1.0 (Epitech-Mag LTD; National Institute of Health (NIH) clinical trials registry #NCT03012698). A placebo-controlled group was also included for comparative analysis, with all subjects being monitored over a three-month period. The evaluation of safety encompassed monitoring changes in best corrected visual acuity, ocular pathology, and the reporting of adverse events. Participant tolerance was gauged through questionnaires, measurements of intraocular pressure (IOP), Schirmer’s test, and vital signs. The efficacy of the treatment was assessed by comparing pre- and post-treatment scores for fluorescein staining (according to National Eye Institute (NEI) grading) and patient-reported outcomes. Results: No statistically significant changes were found in visual acuity, IOP, or Schirmer’s test results between the RMS-treated and control groups (p < 0.05), indicating that RMS does not negatively impact these ocular functions. However, RMS treatment was associated with improved tear film stability (p = 0.19 vs. p = 0.04) and corneal health (p = 0.52 vs. p = 0.004), with no improvements in the control group. Initial symptom improvement was observed in both RMS-treated and placebo groups (p = 0.007 vs. p = 0.008), suggesting a potential therapeutic benefit of RMS for ocular surface conditions beyond a placebo effect. Conclusions: This study presents RMS as a promising therapeutic approach for DED, highlighting its potential to promote corneal epithelial repair, enhance tear film stability, and improve patient-reported symptoms without negatively impacting IOP, visual acuity, or tear production. This confirms the safety and suggests the efficacy of RMS therapy for dry eye conditions. Full article

(This article belongs to the Special Issue Recent Research on Dry Eye)

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25 pages, 1839 KB

Open AccessSystematic Review

Comparative Efficacy of Platelet-Rich Plasma, Autologous Serum, and Artificial Tears in Dry Eye Disease: A Systematic Review and Meta-Analysis

by Alexandra Laura Mederle, Diana Andrei, Laura Andreea Ghenciu, Emil Robert Stoicescu, Roxana Iacob and Ovidiu Alin Haţegan

Biomedicines 2025, 13(9), 2316; https://doi.org/10.3390/biomedicines13092316 - 22 Sep 2025

Cited by 5 | Viewed by 3500

Abstract

Background/Objectives: Dry eye disease (DED) is a prevalent, complex disorder with a major impact on patients’ quality of life. While artificial tears (AT) are still the first-line treatment, their effectiveness is often limited in moderate-to-severe cases. Autologous serum (AS) and platelet-rich plasma (PRP) are now recognized as viable biologic treatments due to their regenerative and anti-inflammatory characteristics. This systematic review and meta-analysis sought to assess and compare the clinical efficacy of PRP, AS, and AT in the treatment of DED, with a focus on comparative studies. Methods: A comprehensive search of PubMed, Scopus, and Google Scholar was conducted until June 2025 for studies directly comparing PRP, AS, and AT. Eligible trials included patients with DED who reported results such as the Schirmer test, tear break-up time (TBUT), and Ocular Surface Disease Index (OSDI). The risk of bias was calculated using ROB 2 for randomized trials and ROBINS-I for non-randomized studies. Meta-analyses were carried out using standardized mean differences (SMDs) and 95% confidence intervals (CIs). Results: Seventeen studies were included in the systematic review. Both PRP and AS demonstrated greater improvements in OSDI, TBUT, and Schirmer test scores compared to AT. PRP showed a trend toward better outcomes than AS, especially in studies using injectable PRP. However, substantial heterogeneity and methodological variability were noted. Conclusions: Comparative research suggests that PRP and AS are more effective than AT in treating DED. Direct comparisons of PRP and AS yield varied results, with the route of delivery impacting outcomes. Given the heterogeneity of current protocols, further standardized, long-term trials are required to confirm the optimal delivery method and ensure safety. Full article

(This article belongs to the Special Issue Recent Research on Dry Eye)

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