# Diabetic dry eye: advances in pathogenesis, diagnostic strategies, and therapeutic approaches

## TL;DR

This review discusses how diabetes increases the risk of dry eye, its causes, diagnostic methods, and new treatment strategies to improve patient outcomes.

## Contribution

The paper provides a comprehensive overview of recent advances in understanding and managing diabetic dry eye.

## Key findings

- Diabetic dry eye is linked to metabolic dysregulation and corneal neuropathy.
- Diagnostic strategies include confocal microscopy and tear fluid biomarkers.
- Therapeutic approaches focus on blood glucose control and neuroregulation.

## Abstract

Dry eye is the most common ocular surface disorder that is increasingly acknowledged to be associated with diabetes mellitus. Via metabolic dysregulation and neural injury, diabetes mellitus significantly increases the prevalence of dry eye, adversely affecting patients’ quality of life. At present, the diagnosis and treatment of diabetic dry eye are still facing challenges in clinical practice. This article outlines the prevalence and risk factors associated with diabetic dry eye, explores its underlying pathogenic mechanisms, such as advanced glycation end-product accumulation, oxidative stress, corneal neuropathy, and impaired neural regulation, which collectively disrupt the lacrimal functional unit, leading to reduced tear secretion and tear film instability. The clinical manifestations of diabetic dry eye are also reviewed. According to current literature, diagnostic strategies utilizing confocal microscopy and tear fluid biomarkers are proposed. In addition, this review summarizes recent therapeutic advances and potential intervention strategies for diabetic dry eye, with a focus on emerging mechanism-based treatments. Taken together, this review aims to advance research on diabetic dry eye and offer novel insights to support early diagnosis and precision therapy.

Created in BioRender. Ting, H. (2026) https://BioRender.com/lv1m7hg.Flowchart summarizing key factors and mechanisms involved in diabetic dry eye. The diagram includes risk factors such as elevated HbA1c and diabetic complications (DR, DN). The classification section illustrates the clinical progression from an initial aqueous-deficient dry eye phenotype to a mixed dry eye type as the disease advances. Pathogenesis panels depict pathological mechanisms initiated by chronic hyperglycemia and metabolic dysregulation. Diagnostic elements include corneal sensitivity assessment using an esthesiometer and tear-based biomarkers. The application section discusses potential mechanism-based therapeutic strategies, including blood glucose control, neuroregulation, antioxidant approaches, and acupuncture.

Created in BioRender. Ting, H. (2026) https://BioRender.com/lv1m7hg.