The evaluation and management of dry anophthalmic socket syndrome

Dry anophthalmic socket syndrome (DASS) is a complex and multifaceted condition that commonly affects patients who have undergone enucleation or evisceration and wear an ocular prothesis. The diagnosis and management of DASS poses significant challenges due to the absence of a standardized diagnostic criteria and evidence-based treatment protocol. Though DASS symptoms can be disproportionate to observable clinical signs, patient-reported outcomes and scoring systems remain the cornerstone of its diagnostic framework. While a dearth of literature exists, parallels can be drawn from other ocular surface conditions, including dry eye disease and contact lens-associated dry eye, regarding inflammatory pathways and surface interactions. DASS is postulated to be related to disruptions to tear film homeostasis, lid margin disease, and chronic inflammation driven by mechanical friction between the prosthesis and socket tissues. We provide a comprehensive review of the pathophysiological processes underlying DASS, discussing current and evolving diagnostic approaches, including use of symptom questionnaires and objective biomarkers such as tear film osmolarity and matrix metalloproteinase-9. Emerging concepts, such as detailed mechanisms of chronic inflammation and the precise nature of mechanical interactions will also be evaluated, alongside future directions for research aimed at optimising guidelines to improve patients' quality of life.