Dry eye syndrome (DES) is a common reason for ophthalmological consultations that can significantly impact patients' quality of life and visual acuity [1, 2, 3, 4]. It can be caused by various factors, including medication usage [5, 6, 7, 8∗, 9∗], hormonal imbalances [10,11], corneal laser refractive surgery [12], systemic diseases [13,14], and allergies [9,15]. This condition results in a chronic cycle of inflammation and eye damage due to disruptions in tear film osmolarity, reduced tear film stability, and loss of tear film homeostasis [16]. This leads to lacrimal gland dysfunction [17], resulting in deficient aqueous dry eye [18,19] and meibomian gland dysfunction, which causes evaporative dry eye - the primary form of DES [15,20].

Artificial tears, tear retention drops, and gels are notably the medications most associated with the management of DES [21,22], as they play a role in symptom management and corneal epithelial wound healing; however, they only provide temporary relief, and not all DES patients benefit from artificial tears. Recently, there has been a focus on anti-inflammatory and immunomodulatory therapies to prevent chronicity and structural changes in the eye [23,24]. However, prolonged use of anti-inflammatory drugs can lead to side effects like glaucoma and cataracts [8,25,26]. At the same time, immunomodulators have a long latency period, and some are poorly tolerated by patients, making treatment adherence challenging [27]. Surgical options such as punctal occlusion [28], minor gland salivary transplants, tarsorrhapy, and amniotic membrane placement can also be considered; however, they do not provide a definitive solution, especially in patients with a significant inflammatory component where retaining tears on the ocular surface can be deleterious [28].

Lately, the focus of treatments has been to restore the natural homeostasis of the ocular surface, putting an end to the vicious circle of DES. Despite the improved knowledge of DES's pathogenesis, there are still several challenges and limitations in treating the disease and, so there remains a need to develop innovative therapies to treat DES. Thus, DES treatment must be personalized and multitargeted, considering etiology, addressing environmental and lifestyle factors, and utilizing a combination of pharmacological and non-pharmacological therapies. Fortunately, there are promising new drugs under development that have the potential to improve patient care significantly.

This review aims to comprehensively examine the latest treatments for DES, encompassing existing options and emerging therapeutics currently under development. An extensive literature search was conducted using PubMed, Cochrane Library, ClinicalTrials.gov, nih.gov, and the American Academy of Ophthalmology website to gather relevant information on these therapies.