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Front. Med., 09 January 2024
Sec. Ophthalmology
Volume 10 - 2023 |

Editorial: Advances in ocular surface disease

  • 1Department of Ophthalmology, Peking University Third Hospital, Beijing, China
  • 2Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
  • 3State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  • 4Department of Ophthalmology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
  • 5Department of Ophthalmology III, CHNO des Quinze-Vingts, Paris, France
  • 6Sorbonne Université, INSERM, CNRS, Institut de la Vision, IHU FOReSIGHT, Paris, France

Editorial on the Research Topic
Advances in ocular surface disease

The ocular surface comprises the conjunctiva, cornea, lacrimal gland, and related eyelid structures (1). Ocular surface disease encompasses a range of disorders impacting its normal structure and function, leading to symptomatic discomfort, visual disturbances, and tear film instability. Common types include dry eye disease, keratitis, conjunctivitis, and pterygium. Systemic conditions like diabetes and graft-vs.-host disease can trigger severe neuropathy and inflammation in ocular surface tissues. Our understanding of ocular surface disease has significantly advanced in recent decades through notable progress in basic and clinical research.

To showcase this, we initiated the Research Topic “Advances in ocular surface disease”, and published five original research articles and one review focusing on etiology, diagnosis, and treatment.

Sleep disorders, part of lifestyle challenges, are linked to increased severity of dry eye symptoms and clinical signs, as well as keratoconus grade (2). Obstructive Sleep Apnea Syndrome (OSAS) involves repeated upper airway obstruction during sleep, leading to arousal with or without oxygen desaturation, posing a significant risk for multi-organ dysfunction. Hao et al. found higher ocular surface disease index (OSDI) and partial blink rates in OSAS patients compared to healthy volunteers. Severe OSAS patients exhibited higher corneal fluorescein staining scores and lower tear break-up time, underscoring the need for heightened ocular surface care in OSAS patients.

Uncontrolled dietary glucose intake and obesity are closely linked to diabetes mellitus (DM). While diabetic retinopathy is well-known, DM also profoundly affects the cornea, leading to diabetic neurotrophic keratopathy, which is estimated to affect 47–64% of diabetic patients (3). Although neurotrophic keratopathy is a major cause of corneal morbidity, the link between diabetes mellitus and keratoconus remains debated. Zhu et al. suggested that higher fasting glucose might genetically reduce the risk of keratoconus by performing Mendelian randomization analysis. The potential mechanism involves heightened collagen cross-linking of cornea in diabetes mellitus patients, indicating that a rational sugar diet strategy might help curbing keratoconus.

Beyond metabolic disorders like diabetes mellitus (DM), various systemic immune conditions pose a threat to ocular surface homeostasis. Ocular graft-vs.-host disease (oGVHD), prevalent in the chronic stage of GVHD post-allogeneic hematopoietic stem cell transplantation, is primarily triggered by an excessive effector T cell immune response in the lacrimal gland, conjunctiva, and cornea, resulting in refractory and prolonged dry eye (4). Based on a series of studies on clinical manifestations, diagnostic biomarkers of oGVHD (4, 5), Shen et al. from Hong Jing's team developed a user-friendly diagnostic model, combining CFS, Schirmer's test score without anesthesia, and conjunctival score, promising reliable screening for chronic oGVHD with an AUC of 0.945. Lacrimal gland fibrosis takes the core position in oGVHD-related DED development. Lin et al. reviewed and summarized advances in clinically examining the lacrimal gland, emphasizing functional assessments focusing on tear quality and quantity, such as TBUT, tear meniscus height, and the tear ferning test, providing crucial diagnostic information for ocular surface diseases impacting the lacrimal gland.

Ocular surface mucosal systems are specialized for eye lubrication and immune defense (6). Cornea is immune-privileged to promise a clear vision, but instead it becomes vulnerable during ocular surface inflammation. In immune-mediated diseases, from corneal transplant rejection to Stevens-Johnson Syndrome, anti-inflammatory agents like corticosteroid derivatives play a crucial role in therapy, preventing corneal opacity and ulcers from the inflammatory cascade. Prolonged corticosteroid use is known to elevate intraocular pressure (IOP). Hence, anti-inflammatory alternatives that don't affect IOP are preferred. RCI001, containing 8-oxo-20-deoxyguanosine (8-oxo-dG), inhibits Rac1 and the NLRP3 inflammasome, making it a novel drug candidate for inflammatory eye diseases. Kim et al. observed that mice treated with RCI001 showed no significant increase in IOP until week 5, suggesting its safety in treating inflammatory ocular surface diseases.

Pterygium is a prevalent ocular surface disease with a global incidence of up to 12%, and involves degeneration and hypertrophy of the bulbar conjunctiva and subconjunctival tissue, extending into the cornea. This progression affects aesthetics and corneal morphology, increases wavefront aberrations, poses irregular astigmatism of the cornea and decrease visual quality. Zhang et al. compared corneal densitometry (CD) values in eyes with pterygium and unaffected eyes using Pentacam. Results showed that pterygium-affected eyes exhibited elevated CD values, especially in the anterior and central layers, aligning with the understanding that pterygium primarily invades Descemet's membrane and the cornea's superficial stromal layer.

Ocular surface diseases disrupt local mucosal homeostasis, causing tear film instability, corneal and conjunctival damage, posing a significant threat to comfort and clear vision. In conclusion, this Research Topic enhanced our understanding of the etiology, diagnosis, and treatment of ocular surface diseases in some aspect, with a specific focus on dry eye disease, keratoconus, ocular graft-vs-host disease (oGVHD), and pterygium.

Author contributions

HQ: Writing—original draft, Writing—review & editing. JY: Writing—review & editing. KY: Writing—review & editing. HL: Writing—review & editing.


The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by National Natural Science Foundation of China (82171022 and 82371026).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


1. Zhang X, Jeyalatha Mani V, Qu Y, He X, Ou S, Bu J, et al. Dry eye management: targeting the ocular surface microenvironment. Int J Mol Sci. (2017) 18:1398. doi: 10.3390/ijms18071398

PubMed Abstract | Crossref Full Text | Google Scholar

2. Galor A, Britten-Jones A, Feng Y, Ferrari G, Goldblum D, Gupta PK, et al. TFOS lifestyle: impact of lifestyle challenges on the ocular surface. Ocul Surf . (2023) 28:262–303. doi: 10.1016/j.jtos.2023.04.008

Crossref Full Text | Google Scholar

3. Yu F-SX, Lee PSY, Yang L, Gao N, Zhang Y, Ljubimov AV, et al. The impact of sensory neuropathy and inflammation on epithelial wound healing in diabetic corneas. Prog Retin Eye Res. (2022) 89:101039. doi: 10.1016/j.preteyeres.2021.101039

PubMed Abstract | Crossref Full Text | Google Scholar

4. Shen Z, Ma J, Peng R, Hu B, Zhao Y, Liu S, et al. Biomarkers in ocular graft-versus-host disease: implications for the involvement of B cells. Transplant Cell Ther. (2022) 28:749.e1–e7. doi: 10.1016/j.jtct.2022.07.023

PubMed Abstract | Crossref Full Text | Google Scholar

5. Hu B, Qiu Y, Hong J. Tear cytokine levels in the diagnosis and severity assessment of ocular chronic graft-versus-host disease(GVHD). Ocul Surf . (2020) 18:298–304. doi: 10.1016/j.jtos.2019.12.005

PubMed Abstract | Crossref Full Text | Google Scholar

6. de Paiva CS, St Leger AJ, Caspi RR. Mucosal immunology of the ocular surface. Mucosal Immunol. (2022) 15:1143–57. doi: 10.1038/s41385-022-00551-6

PubMed Abstract | Crossref Full Text | Google Scholar

Keywords: ocular graft-vs.-host disease, inflammation, diabetes, lacrimal gland, pterygium

Citation: Qi H, Yuan J, Yoon KC and Liang H (2024) Editorial: Advances in ocular surface disease. Front. Med. 10:1357275. doi: 10.3389/fmed.2023.1357275

Received: 17 December 2023; Accepted: 26 December 2023;
Published: 09 January 2024.

Edited and reviewed by: Jodhbir Mehta, Singapore National Eye Center, Singapore

Copyright © 2024 Qi, Yuan, Yoon and Liang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Hong Qi,