Dry eye disease (DED) is a complex multifactorial disease that affects an increasing number of patients worldwide. Close to 30% of the population has experienced dry eye (DE) symptoms and presented with some signs of the disease during their lifetime. The significant heterogeneity in the medical background of patients with DEs and in their sensitivity to symptoms renders a clear understanding of DED complicated. It has become evident over the past few years that DED results from an impairment of the ocular surface homeostasis. Hence, a holistic treatment approach that concomitantly addresses the different mechanisms that result in the destabilization of the tear film (TF) and the ocular surface would be appropriate. The goal of the present review is to compile the different types of scientific evidence (from in silico modeling to clinical trials) that help explain the mechanism of action of cationic emulsion (CE)-based eye drop technology for the treatment of both the signs and the symptoms of DED. These CE-based artificial tear (AT) eye drops designed to mimic, from a functional point of view, a healthy TF contribute to the restoration of a healthy ocular surface environment and TF that leads to a better management of DE patients. The CE-based AT eye drops help restore the ocular surface homeostasis in patients who have unstable TF or no tears.

Biointerfaces and Biomaterials Laboratory Department of Optics and Spectroscopy School of Optometry Faculty of Physics St Kliment Ohridski University of Sofia Sofia Bulgaria

CHNO des Quinze Vingts IHU FOReSIGHT INSERM DGOS CIC 1423 Paris France and Sorbonne Universités INSERM CNRS Institut de la Vision Paris France

Department of Clinical Pharmacology Medical University of Vienna Vienna Austria

Department of Neuroscience Ophthalmology Unit University of Padua Padua Italy

J Heyrovsky Institute of Physical Chemistry Czech Academy of Sciences Prague Czech Republic

Novagali Innovation Center Santen SAS Evry France

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