Advances in the management and therapy of dry eye disease: Insights from TFOS DEWS III

Dry eye disease (DED) is a multifactorial ocular surface disorder driven by tear film instability, hyperosmolar stress, and immune-mediated inflammation, ultimately leading to visual disturbance and reduced quality of life. This review integrates current evidence-based recommendations consistent with the Tear Film and Ocular Surface Society Dry Eye Workshop III (TFOS DEWS III) Diagnostic Methodology and aligns therapeutic interventions with prevalent DED phenotypes to facilitate precision-based management. The proposed stepwise algorithm advances from environmental and behavioral modification, tear supplementation, and ocular surface lubrication to targeted eyelid therapies, anti-inflammatory and immunomodulatory treatments, device-assisted modalities, ocular surface rehabilitation, nutritional supplementation, and perioperative prophylaxis. Given the heterogeneity of disease mechanisms and the variable strength of supporting evidence, DED management must be tailored to individual phenotypic expression and disease severity, with systematic re-evaluation of symptoms, objective clinical parameters, and therapeutic safety.

Keywords: Dry eye disease, ocular surface, DEWS III.