Abstract:Dry eye disease is a widespread, multifactorial ocular condition; its core pathophysiological mechanism involves a self-perpetuating cycle of chronic inflammation driven by the reciprocal activation of innate and adaptive immune responses. Persistent inflammation disrupts tear film homeostasis and elevates tear osmolarity, ultimately leading to a decline in visual function and impaired quality of life. Focusing on the immunopathogenesis of dry eye disease, this article systematically compares the therapeutic targets, clinical evidence, and safety profiles of three representative topical immunomodulators: cyclosporine A, lifitegrast, and tacrolimus. By blocking T-cell activation and proliferation at various stages, these agents interrupt the self-amplifying inflammatory loop and have become central to the long-term management of moderate-to-severe dry eye disease. After analyzing the limitations of existing research, the article highlights the need for future head-to-head clinical trials and the identification of predictive biomarkers to bridge current evidence gaps and guide the rational clinical selection of medications.
