# Emerging Technologies in Corneal Nerve Evaluation for Dry Eye and Ocular Surface Disease: A Review

## TL;DR

New technologies for evaluating corneal nerves are improving the diagnosis and treatment of dry eye and related eye surface diseases.

## Contribution

The paper reviews emerging technologies for assessing corneal nerve structure and function in dry eye and ocular surface diseases.

## Key findings

- Advanced imaging techniques like IVCM and micro-OCT enable detailed in vivo evaluation of corneal nerves.
- Functional methods such as QST and fMRI provide insights into corneal nerve sensory function.
- AI-driven platforms enhance analysis of both structural and functional nerve data for personalized treatment.

## Abstract

Emerging evidence highlights the critical role of corneal nerves in the pathophysiology of dry eye disease (DED) and other related ocular surface disorders (OSDs). These conditions increasingly demonstrate neuropathic and neurotrophic components, wherein alterations in corneal nerve morphology and function contribute to symptomatology and disease progression. Recent advances in imaging and diagnostic modalities have enabled detailed, in vivo evaluation of corneal nerve architecture and sensory function, offering novel insights into underlying mechanisms and therapeutic responses. This review comprehensively examines current and emerging technologies for corneal nerve assessment, both structural and functional. The structural methods include in vivo confocal microscopy (IVCM), optical coherence tomography (OCT)-based nerve imaging (e.g., micro-OCT), and emerging technologies like multiphoton microscopy. The functional methods of corneal nerve assessment include advanced esthesiometers, quantitative sensory testing (QST), and functional magnetic resonance imaging (fMRI). The emerging technologies also include AI-driven analytical platforms that can be applied to both structural and functional methods. These various nerve assessment modalities can aid in delineating DED subtypes, selecting targeted treatments, monitoring nerve regeneration, and predicting treatment outcomes. By integrating structural and functional assessments, these technologies are reshaping the diagnosis, phenotyping, and management of DED and other related OSDs, paving the way for personalized therapeutic approaches.