ObjectivesThe aim of this study was to evaluate the efficacy of intradermal acupuncture for the treatment of moderate to severe dry eye disease (DED).MethodsThirty patients with moderate to severe DED were randomly assigned (11) to either the Intradermal Acupuncture Group (IAG) or the Body Acupuncture Group (BAG). Both groups received 12 treatment sessions over four weeks (three times per week). The primary outcome was the Ocular Surface Disease Index (OSDI). Secondary outcomes included the Visual Analog Scale (VAS) for subjective symptoms, quality of life (QoL), the Schirmer I test (SIT), and general assessment. All outcomes were measured at baseline (Week 0), post-treatment (Week 4), and follow-up (Week 6).ResultsNo statistically significant between-group differences were found in OSDI scores at Weeks 4 and 6 compared to baseline (p = 0.262, p = 0.105). Similarly, changes in VAS, QoL, and SIT scores showed no significant differences between groups (all p > 0.05). No serious adverse events occurred in either group.ConclusionIntradermal acupuncture showed comparable effectiveness to body acupuncture in relieving symptoms of moderate to severe DED, suggesting its potential as an alternative therapeutic option. While between-group differences were not definitive in this pilot study, the findings provide preliminary estimates to inform a future, properly powered non-inferiority trial aimed at determining whether IA can achieve clinically comparable outcomes with potential advantages in convenience and adherence.

ObjectivesAcupuncture has been widely studied for its safety across multiple countries. Sterile acupuncture (SA), represented by the thumbtack needle, is commonly used due to its ease of application, minimal pain, and allowance of free movement. However, it is also associated with adverse events (AEs) such as foreign body sensation and allergic contact dermatitis. Biodegradable microneedle acupuncture (BMA) is a newly developed medical device that may overcome these limitations. This trial aims to confirm the superiority of BMA over SA (represented by the thumbtack needle) in terms of safety.MethodsA total of 224 participants diagnosed with dry eye disease, asthenopia, ocular pain, Bell’s palsy and its sequelae, or ptosis will be recruited from two hospitals. Participants will be randomly assigned to receive either BMA or SA in a 11 ratio. Acupuncture will be performed at eight standardized points bilateral GB14, TE23, EX-HN5, and ST1. Treatments will be administered three times per week for four weeks by Korean medicine doctors or residents with at least three years of clinical experience. The needles will be removed by the participants after four hours. The primary outcome is the incidence of treatment-related AEs. Secondary outcomes include vital signs, blood test results, incidence of allergic reactions, visual analog scale (VAS) scores for symptoms, quality of life, Ocular Surface Disease Index (OSDI) scores, and treatment satisfaction.ConclusionThis trial will provide evidence regarding the safety of BMA. The results may help clinicians select a safer alternative to conventional thumbtack needles, especially for patients with sensitive skin. In addition, findings may serve as reference data for regulatory evaluation of BMA safety and efficacy.

To determine the effects of intense pulsed light (IPL) combined with meibomian gland expression (MGX) and topical medication on ocular rosacea and assess glutathione peroxidases (GPxs) change in the meibum after IPL treatments. Ninety-six eyes of 48 participants with ocular rosacea were randomly assigned to either MGX with erythromycin eye ointment alone (control group) or the combination with IPL (treatment group). During the five visits, participants underwent four IPL or sham IPL sessions at intervals of 2 weeks ± 3 days. The best corrected visual acuity, intraocular pressure, ocular surface disease index (OSDI) questionnaire, lid margin telangiectasia grade, tear break-up time (TBUT), corneal fluorescein staining (CFS), marx line (ML) score, Schirmer's test, meibomian gland yield secretion score (MGYSS), meibography, Demodex were evaluated sequentially. The meibum collected from participants and cryosections of mouse meibomian glands were used for the determination of GPxs or GPx-3. The TBUT revealed significant improvement in the treatment group compared to the control group (p < 0.001). The lower lid margin telangiectasia grade (p < 0.001), MGYSS, lower eyelid ML score and CFS exhibited significant improvement in the treatment group compared to the control group. However, the OSDI score, upper lid margin telangiectasia grade, upper eyelid ML score, Schirmer's test, meibography and Demodex showed no statistical difference between the two groups. The GPxs and GPx-3 showed significant increase after IPL treatment. IPL offered additional benefit in stabilising the tear film, improving the secretion of meibomian gland and reducing abnormal eyelid vascularity. GPxs could be a therapeutic target in IPL treatment.

This prospective, single-arm study investigates the effects of preservative-free artificial tears on ocular symptoms, visual task performance, and tear film stability in visual display terminal (VDT) users. Thirty VDT users with digital eye strain and dryness symptoms were prescribed preservative-free artificial tears four times daily for one month. Ocular Surface Disease Index (OSDI) and Computer–Vision Symptom Scale (CVSS17) questionnaires were collected at four visits (screening, initial, one week and one month). Blink rate and eye fixations during six simple computer tasks and out-loud reading speed were determined before and after computer use. Noninvasive tear film break-up time (NIBUT) and tear meniscus height (TMH) were also recorded. VDT users’ symptoms [CVSS17 (35.70 ± 3.72 to 27.27 ± 4.43; P < 0.01); OSDI (19.99 ± 3.20 to 10.52 ± 6.04; P < 0.01)] improved after artificial tear use at final visit. Out-loud reading speed did not significantly change, although a slight improvement in the normalized value was observed after computer use between the initial (0.99 ± 0.13) and final (1.02 ± 0.15; P < 0.01) visits. No significant differences between visits were found in the blink rate, eye fixations, NIBUT or TMH. Preservative-free artificial tears effectively reduce subjective symptoms in VDT users, although this relief does not translate into measurable improvements in visual task performance or tear film metrics.

Lacrimal gland Ga-68 PSMA-11 PET/CT radiomic profile: a potential novel imaging biomarker in dry eye disease.

This study aimed to evaluate the diagnostic value of DATS compared to conventional tear production assessment methods. The prospective study included 35 patients (70 observations): 34 observations in healthy volunteers, and 36 in patients with DES. The technique for DATS involved visualization of lacrimal gland ducts using fluorescein staining, video recording of secretion, and quantitative analysis of tear fluid volume using specialized software. All participants additionally underwent Schirmer's test, lacrimal meniscometry, and Ocular Surface Diseases Index (OSDI) questionnaire. Statistical analysis was performed using non-parametric tests (Mann-Whitney, Spearman) and ROC analysis with construction of AUC curves and determination of optimal diagnostic thresholds. DATS values differed significantly between groups: 0.68 (0.41; 1.11) μl/min in healthy subjects versus 0.25 (0.04; 0.62) μl/min in dry eye patients (p=0.006). A moderate inverse correlation was found between DATS and OSDI scores (r=-0.41, p<0.001). ROC analysis demonstrated high diagnostic efficacy of DATS (AUC=0.85) with an optimal threshold of 0.3 μl/min (sensitivity 85.3%, specificity 52.8%), outperforming conventional methods. DATS proved its diagnostic value as a method for direct assessment of lacrimal gland function and may become a promising tool in clinical practice. Further studies are needed to standardize the protocol and validate the method in larger patient cohorts with different forms of DES.

The aim of this study was to evaluate the performance and safety of T2769 (Thealoz® Total), a preservative-free eye drop combining 0.15% sodium hyaluronate, 3% trehalose, and 2.45% N-acetylaspartyl-glutamate (NAAGA), in contact lens wearers with dry eye symptoms and discomfort. This prospective, single-arm investigation enrolled 34 adult contact lens wearers with Ocular Surface Disease Index (OSDI) scores ≥ 18 and Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) scores ≥ 12. Patients instilled one drop of T2769 three to six times daily for 36 days. Performance assessments included CLDEQ-8, ocular discomfort and symptoms, OSDI, soothing sensation, and ocular signs. Safety assessments included adverse events (AEs), far BCVA, and ocular tolerance. CLDEQ-8 improved from the baseline at Day 36 (−12.6 ± 5.0; p &lt; 0.001) and as early as D15, with similar improvements in ocular discomfort, OSDI, and total symptom score. Soothing sensation was judged important by 79.4% of patients at D36. Ocular surface staining, tear break-up time, and the Schirmer test improved at D15 and D36, while conjunctival hyperaemia improved in 82.4% of patients at D36. Two non-serious treatment-related AEs (photophobia and blurred vision) occurred in one patient. BCVA was unchanged, and tolerance was rated very satisfactory/satisfactory. In conclusion, T2769 was safe and effective for reducing contact lens-associated dry eyes and discomfort.

To evaluate the tear levels of Lymphotoxin-alpha (LT-α) and the clinical efficacy of intense pulsed light (IPL) treatment in patients with dry eye disease (DED). This randomized study included 28 participants with DED who received 3 IPL therapies at Week 0 (Baseline), Week 3(3W), and Week 6(6W) (N = 30 eyes), or 2 IPL therapies at Baseline, 3W and a sham IPL therapy at 6W (N = 26 eyes). All participants were examined at Baseline, 3W, 6W, Week 9(9W), and Week 12(12W) for non-invasive break-up time (NITBUT), LT-α, meibomian gland quality (MGQ), tear meniscus height (TMH), conjunctivocorneal staining score (CFS), meibomian gland expression (MGEx), tear-film lipid layer (TFLL), and ocular surface disease index (OSDI). Baseline measures exhibited no significant differences between the groups (all p > 0.05). At 6W, NITBUT, MGEx, CFS, and OSDI were significantly improved compared with the Baseline (p < 0.05). At 12W, a comparison between the 3 IPL therapy group and 2 IPL therapy group found significant improvements in the NITBUT (p = 0.002), TMH (p = 0.011), TFLL (p = 0.009), MGEx (p = 0.011), MGQ (p = 0.021), LT-α (p = 0.034), while the CFS (p = 0.104), OSDI (p = 0.189) had no significant improvements. IPL treatment can improve the clinical symptoms and signs of DED. The potential long-term benefit of 3 IPL treatments is better than 2 treatments.Trial registration: ClinicalTrials.gov, TRN: NCT0626923, Registration date: 21 February 2024.

This study aimed to estimate the prevalence, severity, and risk factors of dry eye symptoms (DES) among Iraqi university students and to examine associations with digital device use in an arid, dust-prone setting. A cross-sectional survey was conducted at Al-Mustaqbal University (Iraq) between February and May 2025 using paper-based questionnaires that captured demographics, device-use patterns, symptom burden, and self-management behaviors. Symptom severity was assessed with the Ocular Surface Disease Index (OSDI), and DES prevalence was estimated using the Women’s Health Study (WHS) questionnaire. Binary logistic regression was applied to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Among 1,487 invited students, 1,154 completed the survey (response rate 77.6%); participants were aged 19–24 years, and 63.6% were female. The WHS-defined prevalence of symptomatic DES was 62.0%. Blurred vision, burning, and ocular redness were the most frequent symptoms. A dose–response relationship was observed between daily screen time and OSDI severity, with the highest burden among students reporting more than 7 hours per day (trend p < 0.001). In adjusted models, female participants had higher odds (aOR 2.34; 95% CI 1.56–3.56; p < 0.001), screen time >7 h/day (aOR 2.25; 95% CI 1.55–3.31; p < 0.001), fourth academic year (aOR 1.75; 95% CI 1.18–2.60; p = 0.01), and use of glasses/contact lenses (aOR 1.45; 95% CI 1.10–1.90; p = 0.01) were significant predictors. Laptops were most often associated with ocular redness, smartphones with burning and pain, and tablets with blurred vision. In conclusion, DES symptoms were highly prevalent and strongly associated with prolonged daily screen exposure. Female sex, advanced academic standing, and corrective lens use further increased risk. Findings support campus-level prevention focused on digital hygiene, ergonomic optimization, and periodic ocular screening, considering environmental stressors typical of arid, dust-prone settings.

Purpose: We evaluated the short-term efficacy and safety of hyaluronic acid (HA) eye drops over a 1-month observational period in patients treated with different HA concentrations for dry eye disease.Methods: This prospective, non-interventional, multicenter observational study included patients aged ≥ 19 years who were diagnosed with dry eye at participating medical institutions and treated with HA eye drops (Xenobella SD; ChongKunDang Pharm., Seoul, Korea). In total, 886 eyes from 886 patients were analyzed. Efficacy was evaluated by changes in tear film break-up time (TBUT), ocular surface staining score, dry eye severity, ocular discomfort scale, and the Ocular Surface Disease Index (OSDI) from baseline to 1 month after treatment. Subgroup analyses were conducted to assess efficacy according to age, contact lens use, and HA concentration. Safety was evaluated using a questionnaire on adverse events.Results: After 1 month of treatment, all dry eye parameters―ocular surface staining score, TBUT, ocular discomfort scale, OSDI, and dry eye severity―improved significantly. Subgroup analyses revealed greater improvement in selected parameters, including TBUT, among patients &lt;60 years, contact lens users, and those treated with higher concentrations of HA (0.18% or 0.3%), compared to patients aged ≥60 years, non–contact lens users, and those receiving the lower concentration of HA (0.1%). Only five mild adverse events were reported.Conclusions: This 1-month observational study demonstrated that HA eye drops significantly improved both signs and symptoms of dry eye with minimal adverse events. Therapeutic benefits were more pronounced in younger patients, contact lens users, and those treated with higher HA concentrations (≥0.18%).

Small fiber neuropathy (SFN) is a neurologic condition affecting small-diameter nerve fibers, including those innervating the ocular surface. In this study, we aim to assess the prevalence and characteristics of SFN symptoms in patients with dry eye disease (DED). This was a prospective study conducted at 2 academic eye centers. DED symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire, and adult patients with an OSDI score ≥13 and a clinical diagnosis of DED at Mass Eye and Ear and Beth Israel Deaconess Medical Center were included in the study. Ocular pain was assessed using the Ocular Pain Assessment Survey (OPAS). SFN symptoms were measured using validated Small-Fiber Symptom Survey (SSS) questionnaire, with scores ≥32.5 considered abnormal. DED signs including corneal fluorescein staining (CFS), tear breakup time (TBUT), tear production, and corneal sensitivity were assessed. Patients received standard DED treatments, and their responses were reassessed after 6 to 12 months. Among 31 participants with DED (23-87 years, 80.6% female), 38.7% had abnormal SSS scores. SSS scores correlated with DED symptoms (r = 0.43 P = 0.017) and ocular pain (r = 0.62 P = 0.0003); correlated negatively with CFS (r = -0.42 P = 0.018); and did not correlate with TBUT, tear production, or corneal sensitivity. Despite standard treatments and stable clinical signs, most patients with severe SFN symptoms reported worsening dry eye symptoms in follow-up. This study demonstrates that SFN symptoms were prevalent in DED population and positively correlated with ocular pain and dry eye symptoms and negatively with CFS. Patients with severe SFN symptoms reported less favorable responses to standard dry eye treatments.

ObjectiveTo evaluate the impact of regular refractive correction (spectacle wear) on dry-eye-related parameters and binocular visual function in myopic adults with coexisting dry eye disease (DED).MethodsA cross-sectional observational study enrolled 120 myopic patients with DED, divided into a regular spectacle-wear group (n = 68) and a minimal/non-wear group (n = 52) based on daily spectacle wear duration. Dry eye parameters including tear meniscus height (TMH) and average tear break-up time (Ave TBUT), binocular accommodative function parameters including positive and negative relative accommodation (PRA/NRA), monocular and binocular accommodative facility (AF), and Ocular Surface Disease Index (OSDI) scores were assessed. Correlations between Ave TBUT, TMH, and binocular accommodative function were analysed.ResultsThe regular spectacle-wear group showed significantly longer Ave TBUT and lower OSDI scores (p < 0.05), with no significant TMH difference. Binocular accommodative function was better in the regular spectacle wear group, with significantly lower PRA, higher NRA, and greater monocular/binocular AF (all p < 0.05). Ave TBUT was negatively correlated with PRA and positively correlated with NRA and AF (p < 0.05); TMH showed no significant correlations.ConclusionRegular spectacle wear is associated with improved tear film stability, reduced dry-eye symptoms, and enhanced binocular visual function in myopic patients with dry eye.

This study aimed to evaluate the effectiveness of a specialty nursing program for dry eye disease (DED), developed within the framework of chronic disease management (CDM), in patients with mixed-type DED. A total of 160 patients with mixed-type DED who attended the specialty nursing clinic in a tertiary hospital between January 2024 and January 2025 were enrolled using convenience sampling and randomly allocated to either an experimental group (n=80) or a control group (n=80). Patients in the experimental group received the specialty nursing program for DED based on CDM, whereas those in the control group received routine nursing care. Outcomes were assessed using the Medication Adherence Assessment Scale, the Dry Eye Questionnaire-5 (DEQ-5), tear break-up time (TBUT), and the Ocular Surface Disease Index (OSDI). Measurements were conducted at baseline (T0) and at 2, 4, 6, and 8 weeks after the intervention (T1-T4) to evaluate medication adherence and treatment-related outcomes. There were no statistically significant differences in baseline characteristics or preintervention assessments between the 2 groups (P>0.05). Following the intervention, patients in the experimental group demonstrated significantly higher scores on the Medication Adherence Assessment Scale, improved DEQ-5 and OSDI scores, and longer TBUT values across T1 to T4 compared with the control group (P<0.001). Implementation of a specialty nursing program for DED within the framework of CDM effectively improved medication adherence, enhanced tear film stability, and reduced symptom severity in patients with mixed-type DED. These findings provide a scientific foundation for the development of personalized and standardized management strategies for patients with DED.

ABSTRACT Purpose To assess the duration, reversibility, alterations and prognosis of ocular adverse events (AEs) in participants treated with bemarituzumab, a first-in-class FGFR2b-targeted inhibitor in FGFR2b-overexpressing gastric/gastroesophageal junction cancer (G/GEJC), and to propose early intervention management strategy. Methods This was a prospective, observational study of 11 participants with FGFR2b-overexpressing G/GEJC treated with bemarituzumab. All participants received ocular evaluations at baseline, and subsequent 6-week intervals. Evaluations included best-corrected visual acuity (BCVA), dry eye examinations, corneal morphology analysis, and fundus photography. Results 11 participants occurred ocular AEs, 8 participants finished the study. BCVA loss was first detected on day 131.5 ± 40.2 post-baseline (6.6 ± 2.5 doses following the initial bemarituzumab administration), with a loss of 2.1 ± 0.7 lines. Ocular Surface Disease Index (OSDI) scores increased (55.1 ± 18.1) at week 18. Corneal alterations manifested as punctate epitheliopathy, arc-shaped corneal defects, and ulcerative keratitis. In vivo confocal microscopy (IVCM) demonstrated features of corneal dysmaturation, including intraepithelial microcysts and abnormally thickened, cord-like structures within the basement membrane layer. After 134.1 ± 55.0 days of administering topical eye drops, the BCVA, dry eye and corneal epithelial alterations returned to baseline levels. Prophylactic administration of FGF-based eye drops helped prevent bemarituzumab treatment discontinuation, alleviated drug-related ocular symptoms, and improved prognosis. Conclusions The ocular AEs occurred frequently in patients receiving bemarituzumab, requiring close ophthalmic monitoring and prophylactic administration of FGF-based eye drops. Collaboration between oncologists and ophthalmologists is critical for the timely management of treatment-related AEs, which could ultimately improve overall clinical outcomes.

We compared the efficacy of intense pulsed light (IPL) therapy alone and combined with eyelid margin cleaning using a deep cleaning device for the treatment of meibomian gland dysfunction (MGD). In this single-center, investigator-masked randomized controlled trial, eyelid margin cleaning was performed using an OCUFACE device (Guangzhou Ocuface Biotechnology Co., Ltd.). Treatment efficacy was compared between the intervention and control groups based on changes in the clinical indicators from baseline. The primary outcomes were the improvement of meibomian gland secretion quality, changes in the Ocular Surface Disease Index (OSDI) score, and the improvement of tear film stability (e.g., tear break-up time). Data from 120 eyes of 60 patients with MGD were included in the final analysis. The changes in the OSDI (p = 0.021) and nasal-region meibomian gland function (p = 0.022) differed significantly between groups. The change in temporal-region meibomian gland function had a similar trend, but the difference was not significant (p = 0.25). The mean value for lower-eyelid meibomian gland loss was significantly lower in the intervention group than in the control group (0.85 vs. 1.12, p = 0.045). The median NIBUT after treatment was significantly longer in the intervention group than in the control group (5.45 vs. 3.05s, p = 0.008). IPL therapy combined with deep eyelid margin cleaning alleviates meibomian gland orifice obstruction and improves tear film stability. This study establishes a new treatment paradigm, with a shift from passive thermal modulation to active ductal remodeling. This research was retrospectively registered in the Chinese Clinical Trial Registry (CTR2400092860, 2024/11/25).

Background: Blepharoplasty rectifies functional and aesthetic problems of the periorbital area. Objective: This study tests the effectiveness of a combined procedure of blepharoplasty and fractional ablative CO2, resurfacing on a total of 16 patients diagnosed with dermatochalasis and surgical indication for upper blepharoplasty. Methods: Patients underwent a combined procedure of blepharoplasty and fractional ablative CO2 resurfacing. The examinations performed were: measurement of the height of the lacrimal meniscus, tear break-up time (FBUT), Schirmer test and Ocular Surface Disease Index questionnaire. Results: All values returned to baseline 150 days (5 months) from surgery with improvement of the FBUT value. No significant change or worsening in values was observed after laser application and periorbital blepharoplasty. Conclusions: The application of fractional CO2 laser and blepharoplasty could lead to both psychological and social improvement in patients, reducing the potential risks that can lead to dry eye syndrome.

To compare the results of the Ocular Surface Disease Index (OSDI), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment Questionnaire iN Dry Eye (SANDE) in patients without glaucoma and with glaucoma at different stages of severity. Cross-sectional study including patients who underwent visual field (VF) testing, completed three dry eye disease (DED) questionnaires and had ocular surface examination. Glaucoma severity was staged by averaging the severity grade of both eyes using mean deviation (MD) thresholds as mild (MD≥-6 dB), moderate (-6>MD≥-12 dB) and advanced (MD<-12 dB). Questionnaire results, pairwise correlations and predictors for each questionnaire result were assessed. 147 patients with a mean age of 65.8±12.5 years were included. OSDI showed moderate-to-high correlations with DEQ-5 and SANDE in patients without glaucoma (n=43) and with mild-to-moderate (n=32 and n=56) VF damage (always ρ≥0.55; p<0.01 with DEQ-5 and ρ≥0.5; p<0.01 with SANDE); while correlations became low and non-significant in advanced glaucoma (n=16) (ρ:0.38; p=0.60 and ρ:0.41; p=0.464 with DEQ-5 and SANDE, respectively). Conversely, DEQ-5 and SANDE always showed significant correlations (ρ≥0.66; p<0.01). Linear regression showed the OSDI to be the only questionnaire affected by mean MD (p=0.002). Additionally, glaucoma patients were more frequently defined as symptomatic for DED using the OSDI compared with the DEQ-5 (65.4% vs 51.9%; p=0.0082). DED questionnaires showed different behaviours in patients with glaucoma. The OSDI failed to maintain its correlation with both the DEQ-5 and SANDE in advanced glaucoma stages and was the only questionnaire influenced by VF damage. Questionnaire choice may influence how DED symptoms are captured in glaucoma patients, particularly in advanced stages.

Secondary dry eye disease in breast cancer patients: a pilot study

Background: Type 2 diabetes mellitus (T2DM) is increasingly recognized as affecting not only the retina but also the ocular surface. Chronic hyperglycemia can disrupt meibomian gland function, reduce tear secretion, and impair corneal sensitivity, leading to tear film instability and symptoms of dry eye disease. However, previous studies have reported variable findings, and the extent of these alterations remains uncertain. Methods: Following PRISMA guidelines, this systematic review and meta-analysis evaluated observational studies that compared tear film parameters between adults with T2DM and non-diabetic controls. Eligible studies assessed one or more of the following: invasive or non-invasive tear break-up time, Schirmer test, tear meniscus height, or Ocular Surface Disease Index (OSDI). Results: Twenty-four studies involving approximately 3500 eyes were included. Most reported significantly reduced tear stability and secretion in diabetic participants compared with controls. Tear break-up times were consistently shorter in T2DM, indicating a less stable tear film. Schirmer test results demonstrated lower tear production correlated with diabetes duration and poor glycemic control. Tear meniscus height was modestly reduced in T2DM, reflecting decreased tear reservoir volume. Subjective symptoms, as measured by OSDI, were generally higher among patients with T2DM, suggesting greater ocular surface discomfort. Conclusions: T2DM is strongly associated with tear film instability, reduced tear secretion, and increased dry eye symptoms. These findings suggest that diabetic care should include routine ocular surface assessment and highlight the need for standardized, longitudinal investigations.

The study aimed to compare the efficacy of intense pulsed light (IPL), 0.05% cyclosporine A (CsA) eye drops, and 3% diquafosol sodium (DQS) eye drops in treating moderate to severe dry eye. A cohort of 180 patients diagnosed with moderate to severe dry eye was enrolled in the Department of Ophthalmology at Quzhou People’s Hospital between October 2, 2023, and October 2, 2024. The patients were randomly assigned to 3 treatment groups: IPL, 0.05% CsA, and 3% DQS, with each group consisting of 60 patients. Ocular surface parameters were assessed at 4-week and 12-week intervals after the initiation of treatment. The primary outcome measure was the change in the corneal fluorescein staining score (CFSS), used to evaluate the therapeutic efficacy of IPL, 0.05% CsA, and 3% DQS eye drops. The secondary outcomes included the Ocular Surface Disease Index (OSDI), Schirmer Tear Test 1 (STT1), tear meniscus height (TMH), and tear breakup time, used to evaluate treatment efficacy. At week 4 post-treatment, the CsA, DQS, and IPL groups demonstrated statistically significant differences in average NBUT, OSDI score, TMH, and STT1 score (P < .05). The IPL group achieved the most favorable outcomes, showing the highest NBUT, TMH, and STT1 scores, along with the lowest OSDI score. Although CFSS values varied among the groups, the differences were not statistically significant (P > .05). At week 12 post-treatment, significant differences (P < .05) were observed among the CsA, DQS, and IPL groups across multiple parameters. The IPL group continued to show superior results, with the highest tear film breakup time, TMH, and STT1 scores, as well as the lowest OSDI and CFSS values. IPL, 0.05% CsA, and 3% DQS eye drops are effective in treating moderate to severe dry eye. Notably, IPL shows significant advantages over CsA and DQS, owing to its noninvasive nature, effective clearance of meibomian gland obstruction, and marked improvement in tear film quality.