The Therapeutic Potential of Exosomes in Ocular Surface Diseases

The ocular surface system, essential for maintaining visual function, is highly susceptible to a range of ocular surface diseases (OSDs) that significantly impair patients' quality of life. Current treatments for OSDs often face limitations including low bioavailability, A lack of targeted delivery, and an inadequate capacity to fully address the complex pathophysiology involving inflammation, oxidative stress, and impaired tissue repair. In recent years, exosomes have emerged as promising cell-free therapeutic platforms for OSDs. This review evaluates their therapeutic potential across the OSD spectrum, focusing on three key aspects: mechanisms-modulation of inflammation, oxidative stress, and tissue repair via bioactive cargo; applications-preclinical therapeutic effects in dry eye disease, corneal injury, keratitis, and transplant rejection; and optimization strategies-engineering approaches and biomaterial integration to enhance stability, targeting, and ocular retention. We also discuss critical challenges in standardization, scalable production, and clinical translation, highlighting future directions for exosome-based OSD therapies.