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Ocular Surface Disease: Epidemiology, Diagnosis and Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 20 July 2026 | Viewed by 2440

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Special Issue Editors

Dr. Sandeep K. Dhallu

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Guest Editor

1. Optometry and Vision Sciences Research Group, Aston University, Birmingham AL10 9AB, UK
2. Optometry, Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, Hatfield AL10 9EU, UK
Interests: optometry; dry eye; cornea; ocular nutrition, contact lenses; intraocular lenses
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Dr. Nicole Carnt

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Guest Editor

School of Optometry and Vision Science, University of NSW, Sydney, NSW 2052, Australia
Interests: optometry; vision; ophthalmology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Researchers, scientists, and eye care professionals are invited to submit their latest work for publication in our upcoming Issue on Ocular Surface Disease: Epidemiology, Diagnosis and Management.

Ocular surface health plays a critical role in maintaining normal vision and may be affected by several disease processes, often requiring a multifaceted treatment approach. Ocular surface diseases, such as dry eye disease, have been the focus of extensive research in recent years, leading to significant advances in our understanding. The objective of this Special Issue is to summarize the latest research covering the risk factors, prevalence, diagnosis, and treatment of ocular surface diseases.

We welcome original articles as well as reviews providing fresh insights into the risk factors, development, diagnosis, and treatment of these disorders. We look forward to receiving your valuable contribution to this Special Issue.

Many thanks, and I look forward to working with you.

Dr. Sandeep K. Dhallu
Dr. Nicole Carnt
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

dry eye disease
risk factors
ocular surface disease
inflammatory biomarkers
anterior segment imaging
emerging therapies

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Published Papers (3 papers)

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Research

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22 pages, 3725 KB

Open AccessArticle

Diurnal Variation, Topographical Distribution and Day-to-Day Repeatability of Ocular Surface Epithelial Immune Cells in Individuals with Dry Eye Disease

by Soumen Sadhu, Isabelle Jalbert, Blanka Golebiowski and Fiona Stapleton

J. Clin. Med. 2026, 15(7), 2582; https://doi.org/10.3390/jcm15072582 - 27 Mar 2026

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Abstract

Objectives: To assess diurnal changes, topographical differences, and day-to-day repeatability of ocular surface epithelial immune cell (EIC) density and morphology in dry eye disease (DED). Methods: Sixteen participants with moderate-to-severe DED (mean (SE) age 49.4 (4.2) years) underwent in vivo confocal microscopy at three timepoints (day-1 morning and evening and day-2 morning) at six locations: central cornea, inferior whorl, inferior cornea, and temporal cornea, limbus and conjunctiva. Diurnal and topographical variation in EIC density and morphology were analyzed using linear mixed-effects models with adjusted pairwise comparisons. Day-to-day repeatability was assessed using the coefficient of repeatability (CoR) for density and Cohen’s kappa for morphology. Results: EIC density and morphology varied by location (p < 0.001) but not by timepoint at any location (p = 0.59–0.90). Density was highest at the inferior cornea (model-estimated mean: 101.2 (SE: 21.7) cells/mm²) and temporal limbus (104.3 (22.7) cells/mm²), and lowest at the central cornea (26.8 [5.1] cells/mm² and inferior whorl (38.3 [8.2] cells/mm²; all pairwise, p < 0.001). EICs with large bodies were more frequent in conjunctiva (100%), inferior cornea (94%), and temporal cornea (87%), than in central cornea (34%) and whorl (19%) (all p ≤ 0.007). EICs with dendrites, and with long dendrites were similarly distributed (p < 0.001). Bland–Altman analysis showed low mean bias and EIC density was more repeatable at the central (CoR ± 23.8 cells/mm²) and temporal cornea (±27.5 cells/mm²) than the inferior cornea (±47.9 cells/mm²) or temporal conjunctiva (±42.3 cells/mm²). Morphology agreement was substantial to near-perfect (κ = 0.71–0.97). Conclusions: In DED, EIC density and morphology are diurnally stable and maintain topographic distribution patterns similar to healthy eyes. Day-to-day repeatability show location dependent patterns. The study provides feasibility data for using IVCM for EIC metrics in disease monitoring. Full article

(This article belongs to the Special Issue Ocular Surface Disease: Epidemiology, Diagnosis and Management)

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19 pages, 2050 KB

Open AccessArticle

Dual Evaluation of Malva Extract in Eye-Drop Formulations: Antioxidant Efficacy and Physicochemical Properties Relevant to the Treatment of Dry Eye Disease

by Johann Röhrl, Maria-Riera Piqué-Borràs, Mónica Mennet-von Eiff and Gerald Künstle

J. Clin. Med. 2026, 15(5), 1869; https://doi.org/10.3390/jcm15051869 - 28 Feb 2026

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Abstract

Background/Objectives: Dry eye disease (DED) is a multifactorial condition affecting the ocular surface. It is characterized by tear film instability, hyperosmolarity, inflammation, and oxidative stress. First-line treatment for DED relies on lubricating and hydrating eye drops, usually containing hyaluronic acid (HA), which supports tear film stability and epithelial healing. However, HA alone cannot correct oxidative stress, a key driver of cellular damage and inflammation in DED. Accordingly, this study aimed to evaluate the antioxidant capacity of Malva sylvestris tincture (MalvaT) and its physicochemical properties in experimental eye-drop formulations containing HA. Methods: The antioxidant activity of reconstituted MalvaT lyophilisate (Malva) was assessed in cell-free assays against several oxygen radicals and in cell-based assays using the human HaCat keratinocyte cell line. The refractive index was measured in eye-drop formulations containing 0.15% or 0.3% HA and 0.5% MalvaT. Surface tension was assessed in eye-drop formulations containing 0.15% HA and increasing concentrations (0.25–2.0%) of MalvaT. Results: Malva showed potent oxygen radical scavenging activity in both cell-free and cell-based assays, indicating its antioxidant capacity and the efficient cellular uptake of antioxidant components. The refractive indices of experimental eye-drop solutions containing HA and MalvaT were close to that of tear fluid (1.334). The surface tension of the experimental eye-drop formulations, while not impacted by 0.15% HA, was significantly reduced by increasing concentrations of MalvaT (p < 0.0001). At the concentration of 0.5% MalvaT, the mean surface tension was reduced from 68.17 mN/m (HA control) to 59.80 mN/m (HA + MalvaT), thereby bringing it closer to that of tear fluid. Conclusions: This pre-clinical study suggests that combining the antioxidant properties of Malva tincture with the lubricating and hydrating effects of HA in eye-drop formulations exhibiting optimal rheological characteristics may offer a promising therapeutic approach for managing DED. Full article

(This article belongs to the Special Issue Ocular Surface Disease: Epidemiology, Diagnosis and Management)

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Review

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21 pages, 16353 KB

Open AccessReview

Anterior Segment Optical Coherence Tomography with Angiography for the Cornea and Ocular Surface

by Qiu Ying Wong, Ralene Sim and Marcus Ang

J. Clin. Med. 2026, 15(6), 2402; https://doi.org/10.3390/jcm15062402 - 21 Mar 2026

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Abstract

Background/Objectives: Anterior segment optical coherence tomography (AS-OCT) and optical coherence tomography angiography (AS-OCTA) have enhanced the evaluation of the cornea, ocular surface, and ocular surface diseases (OSD), offering high-resolution structural and anterior segment vascular imaging. This review summarizes recent advances in these modalities and their clinical applications. Methods: A comprehensive literature search was conducted using PubMed, Web of Science, and Google Scholar with the terms OCT, OCTA, anterior segment, and ocular surface disease. Studies published in the past five years were included, emphasizing more recent developments such as ultra-high-resolution AS-OCT (UHR-AS-OCT) and swept-source AS-OCTA technologies. Results: UHR-AS-OCT provides non-invasive, sub-micron imaging of the cornea and the ocular surface, including tear film morphology and epithelial thickness to correlate with clinical tests such as tear break-up time, and fluorescein staining. Advances in AS-OCTA allow dye-free, depth-resolved imaging of corneal and conjunctival vasculature. These vascular biomarkers have shown promising utility in conditions such as limbal stem cell deficiency, chemical ocular injury, and ocular surface squamous neoplasia. Improvements in image acquisition, motion correction, and segmentation algorithms have enhanced accuracy and repeatability, supporting broader clinical translation. Conclusions: AS-OCT and AS-OCTA have become useful adjunctive imaging tools for the cornea and ocular surface evaluation. Their non-invasive, quantitative, and reproducible metrics may enable earlier diagnosis, objective staging, and longitudinal monitoring of OSD. Integration of OCT-based imaging with artificial intelligence and multimodal data, including tear proteomics and meibography, may optimize personalized treatment for ocular surface disorders. Full article

(This article belongs to the Special Issue Ocular Surface Disease: Epidemiology, Diagnosis and Management)

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