Towards a dynamic customised therapy for ocular surface dysfunctions

The ocular surface is a highly dynamic system characterised by continuous adaptive reactions to environmental, toxic, infective, traumatic and inflammatory conditions that interfere with its homeostasis. When the adaptive response is not able to cope with environmental or internal aggressions, a persisting dysfunction may develop into a self-maintaining vicious cycle, thereby developing a chronic disease. This process is not even, but characterised by cycles of worsening and improvement accompanied by morphofunctional changes of the ocular surface structure. The therapy for this condition cannot be unique and stable all along the course of the disease, but should be adapted to the modifications occurring on the ocular surface. It should be long term and dynamic, in order to be tailored on each patient's conditions. An ideal therapeutic strategy should address simultaneously the main targets: tear film quality and stability, morphofunctional changes of the epithelia, the obvious and subclinical inflammation, and the structural and functional changes of nerves. The avoidance of schematic approaches and the customisation of the therapy, modified according to the disease presentation, will be highly desirable and will open to a patient-oriented approach, granting a more prompt and stable improvement of the ocular surface with better-tolerated therapies.