Dry Eye Disease: Current Concepts in Diagnosis and Management—A Narrative Review

Abstract

Dry eye disease (DED) is a common, multifactorial ocular surface disorder characterized by loss of tear film homeostasis, resulting in ocular discomfort, visual disturbances, and impaired quality of life. This review provides an overview of the classification, epidemiology, risk factors, pathophysiology, clinical manifestations, diagnostic evaluation, and management of DED. The disease is broadly classified into aqueous-deficient and evaporative dry eye, although both mechanisms frequently coexist. Tear film instability, hyperosmolarity, ocular surface inflammation, epithelial damage, and neurosensory abnormalities play important roles in disease development and progression. Several factors, including ageing, hormonal changes, systemic diseases, prolonged digital screen use, environmental conditions, medications, and contact lens wear, contribute to its occurrence. Clinical diagnosis requires a comprehensive evaluation of symptoms and ocular surface findings using tests such as Schirmer's test, tear breakup time, ocular surface staining, and tear osmolarity assessment. Management involves patient education, lifestyle modifications, artificial tears, anti-inflammatory treatment, and targeted therapies according to disease severity and underlying causes. Emerging technologies, including artificial intelligence, advanced ocular imaging, and tear biomarker analysis, may improve diagnostic accuracy and support individualized treatment. A better understanding of the underlying disease mechanisms and the development of effective therapeutic strategies are essential for improving long-term outcomes in patients with DED.