Updates in immunomodulator therapy in ocular surface inflammatory diseases

Ocular surface inflammatory disorders (OSIDs), including allergic conjunctivitis, ocular graft-versus-host disease (oGVHD), and cicatrizing conjunctivitis, present significant clinical challenges due to complex immune modulation. Traditional therapies like corticosteroids have limitations, prompting the need for alternative treatments. This review explores novel, steroid-sparing immunomodulatory options.

In recent years, immunomodulatory therapies have evolved from corticosteroids and broad-spectrum T-cell inhibitors such as cyclosporine and tacrolimus to more selective pathway-targeting agents like JAK inhibitors (e.g., ruxolitinib). Biologic agents, including dupilumab and upadacitinib, have demonstrated efficacy in severe allergic conjunctivitis. In oGVHD, JAK inhibitors and combination therapies are emerging as promising strategies. For cicatrizing conjunctivitis, rituximab and IVIg have shown encouraging outcomes. Additionally, novel therapeutic targets such as chemokine receptor blockers (e.g., CCL20 locked dimer), T regulatory cell (Treg) modulation, and transcriptional modification via micro-RNA are shaping the future of ocular surface disease management.

The future of immunomodulatory therapy for ocular surface diseases lies in refining current treatment approaches and advancing targeted biologic agents that modulate specific immune pathways, offering improved efficacy and safety for patients with these sight-threatening conditions.