Immunomodulation of the Ocular Surface in Severe Dry Eye Disease: Expert-Driven Literature Review on Treatment Strategies with Description of Representative Challenging Cases

Autoimmune-related DED requires a stepwise treatment regimen for the stabilization of the ocular surface and the prevention of irreversible damage. This approach involves an initial short course of corticosteroids, followed by sustained immunomodulation (with CsA as the cornerstone), and supplemented by adjunctive therapies targeting meibomian glands and ocular surface epithelium. Multidisciplinary coordination and regular monitoring are essential for maintaining long-term ocular surface homeostasis and satisfactory quality of life and visual function.