{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T06:47:53Z","timestamp":1774594073599,"version":"3.50.1"},"reference-count":81,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Menopause is a significant risk factor for dry eye disease (DED), conventionally explained by estrogen deficiency and diminished tear production. Recent evidence, however, highlights the pivotal role of immune-inflammatory mechanisms in its development. This mini-review aims to integrate contemporary insights into the immuno-inflammatory pathways active in menopausal DED, clarifying how variations in sex hormones initiate and perpetuate immune dysregulation within the ocular surface microenvironment. We propose that menopausal DED is not solely a disorder of inadequate lubrication but rather a chronic immune-mediated inflammatory state, propelled by hormonal shifts. Its pathology is defined by a self-sustaining cycle of T cell-led inflammation, loss of goblet cells, and neurosensory dysfunction, which together exacerbate ocular surface impairment and clinical symptoms.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1732320","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T05:19:17Z","timestamp":1774588757000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Immuno-inflammatory axis of menopausal dry eye: from hormonal fluctuations to ocular surface dysregulation"],"prefix":"10.3389","volume":"17","author":[{"given":"Zi-ting","family":"Tian","sequence":"first","affiliation":[{"name":"Department of Traditional Chinese Medicine External Medicine, College of Traditional Chinese Medicine, Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-ying","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine External Medicine, College of Traditional Chinese Medicine, Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong-bo","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine External Medicine, College of Traditional Chinese Medicine, Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao-kang","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine External Medicine, College of Traditional Chinese Medicine, Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong-yun","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine, Hainan Women and Children\u2019s Medical Center","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan-yang","family":"Pang","sequence":"additional","affiliation":[{"name":"Department of Traditional Chinese Medicine External Medicine, College of Traditional Chinese Medicine, Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sjopt.2014.06.002","article-title":"Dry eye disease: a review of diagnostic approaches and treatments","volume":"28","author":"Lin","year":"2014","journal-title":"Saudi J Ophthalmol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-067007","article-title":"Patient-reported burden and overall impact of dry eye disease across eight European countries: a cross-sectional web-based survey","volume":"13","author":"Boboridis","year":"2023","journal-title":"BMJ Open"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.54028","article-title":"Dry eye disease: an overview of its risk factors, diagnosis, and prevalence by age, sex, and race","volume":"16","author":"Deo","year":"2024","journal-title":"Cureus"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.17.2114","article-title":"Hormone replacement therapy and dry eye syndrome","volume":"286","author":"Schaumberg","year":"2001","journal-title":"JAMA"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/GME.0000000000000530","article-title":"Dry eye in postmenopausal women: a hormonal disorder","volume":"23","author":"Sriprasert","year":"2016","journal-title":"Menopause"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000012572","article-title":"Sex hormone therapy's effect on dry eye syndrome in postmenopausal women: a meta-analysis of randomized controlled trials","volume":"97","author":"Liu","year":"2018","journal-title":"Med (Baltimore)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1080\/08820538.2025.2522716","article-title":"Immunological impact of sex hormones at ocular surface: a narrative review","volume":"41","author":"Ferraro","year":"2026","journal-title":"Semin Ophthalmol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/j.jtos.2017.04.001","article-title":"TFOS DEWS II sex, gender, and hormones report","volume":"15","author":"Sullivan","year":"2017","journal-title":"Ocul Surf"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1210\/er.2007-0001","article-title":"The complex role of estrogens in inflammation","volume":"28","author":"Straub","year":"2007","journal-title":"Endocr Rev"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1097\/01.ico.0000160973.04072.a5","article-title":"Estrogen stimulation of proinflammatory cytokine and matrix metalloproteinase gene expression in human corneal epithelial cells","volume":"24","author":"Suzuki","year":"2005","journal-title":"Cornea"},{"key":"B11","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.exer.2011.12.016","article-title":"Influence of sex hormones and genetic predisposition in Sj\u00f6gren's syndrome: a new clue to the immunopathogenesis of dry eye disease","volume":"96","author":"Mostafa","year":"2012","journal-title":"Exp Eye Res"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.4103\/jmh.JMH_41_17","article-title":"Dry eye syndrome in menopause and perimenopausal age group","volume":"8","author":"Peck","year":"2017","journal-title":"J Midlife Health"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.85.12.7072","article-title":"Effect of androgen deficiency on the human meibomian gland and ocular surface","volume":"85","author":"Krenzer","year":"2000","journal-title":"J Clin Endocrinol Metab"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.4103\/IJO.IJO_2887_22","article-title":"Hormones and dry eye disease","volume":"71","author":"Gorimanipalli","year":"2023","journal-title":"Indian J Ophthalmol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"26096","DOI":"10.1038\/s41598-025-03638-9","article-title":"Evaluation of the therapeutic effect of estrogen replacement therapy combined with autologous serum therapy in controlling severe dry eye disease in perimenopausal women","volume":"15","author":"Li","year":"2025","journal-title":"Sci Rep"},{"key":"B16","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s12886-025-03866-7","article-title":"Changes in tear cytokine and lactoferrin levels in postmenopausal women with primary acquired nasolacrimal duct obstruction complicated with obstructed meibomian gland dysfunction","volume":"25","author":"Jin","year":"2025","journal-title":"BMC Ophthalmol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1097\/ICL.0000000000000289","article-title":"Relationship between dynamic changes in expression of IL-17\/IL-23 in lacrimal gland and ocular surface lesions in ovariectomized mice","volume":"44","author":"Li","year":"2018","journal-title":"Eye Contact Lens"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.19-26815","article-title":"Testosterone influence on gene expression in lacrimal glands of mouse models of Sj\u00f6gren syndrome","volume":"60","author":"Morthen","year":"2019","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.732887","article-title":"Recent developments about the pathogenesis of dry eye disease: based on immune inflammatory mechanisms","volume":"12","author":"Yu","year":"2021","journal-title":"Front Pharmacol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3109\/02713683.2014.966847","article-title":"Sex-steroid imbalance in females and dry eye","volume":"40","author":"Versura","year":"2015","journal-title":"Curr Eye Res"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3390\/ijms24065609","article-title":"Expression of androgen and estrogen receptors in the human lacrimal gland","volume":"24","author":"Hat","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3980\/j.issn.2222-3959.2012.01.13","article-title":"Effects of estrogen replacement therapy on apoptosis and vascular endothelial growth factor expression in ocular surface epithelial cells: an experimental study","volume":"5","author":"Ozcura","year":"2012","journal-title":"Int J Ophthalmol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1038\/sj.eye.6701314","article-title":"Detection of oestrogen receptors (ER) alpha and beta in conjunctiva, lacrimal gland, and tarsal plates","volume":"18","author":"Spelsberg","year":"2004","journal-title":"Eye (Lond)"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.01-1276","article-title":"Regulation of estrogen receptors and MMP-2 expression by estrogens in human retinal pigment epithelium","volume":"44","author":"Marin-Casta\u00f1o","year":"2003","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B25","article-title":"Identification of estrogen and progesterone receptor mRNA expression in the conjunctiva of premenopausal women","volume":"43","author":"Fuchsj\u00e4ger-Mayrl","year":"2002","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B26","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1507\/endocrj.EJ20-0178","article-title":"The applications of androgen in the treatment of dry eye disease: a systematic review of clinical studies","volume":"67","author":"Wang","year":"2020","journal-title":"Endocr J"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1429154","article-title":"The relationship between sex hormone levels and ocular surface parameters in girls with idiopathic central precocious puberty","volume":"15","author":"Jiang","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.12-10457","article-title":"The effects of estrogen and androgen on tear secretion and matrix metalloproteinase-2 expression in lacrimal glands of ovariectomized rats","volume":"55","author":"Song","year":"2014","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/j.clim.2015.09.014","article-title":"IL-17-producing \u03b3\u03b4T cells are regulated by estrogen during development of experimental arthritis","volume":"161","author":"Andersson","year":"2015","journal-title":"Clin Immunol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.01713","article-title":"Effect of dry eye disease on the kinetics of lacrimal gland dendritic cells as visualized by intravital multi-photon microscopy","volume":"11","author":"Ortiz","year":"2020","journal-title":"Front Immunol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1001\/archophthalmol.2011.364","article-title":"Dry eye disease: an immune-mediated ocular surface disorder","volume":"130","author":"Stevenson","year":"2012","journal-title":"Arch Ophthalmol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.4103\/IJO.IJO_481_23","article-title":"Intricate insights into immune response in dry eye disease","volume":"71","author":"Kaur","year":"2023","journal-title":"Indian J Ophthalmol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.4110\/in.2019.19.e3","article-title":"Age-related autoimmune changes in lacrimal glands","volume":"19","author":"de Souza","year":"2019","journal-title":"Immune Netw"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.08-2417","article-title":"Characterization of effector T cells in dry eye disease","volume":"50","author":"El Annan","year":"2009","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.182.3.1247","article-title":"Autoimmunity in dry eye is due to resistance of Th17 to Treg suppression","volume":"182","author":"Chauhan","year":"2009","journal-title":"J Immunol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.849990","article-title":"IL-17 producing lymphocytes cause dry eye and corneal disease with aging in RXR\u03b1 mutant mouse","volume":"9","author":"Alam","year":"2022","journal-title":"Front Med (Lausanne)"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.11-7627","article-title":"Correlation of tear inflammatory cytokines and matrix metalloproteinases with four dry eye diagnostic tests","volume":"53","author":"VanDerMeid","year":"2012","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.17-23651","article-title":"Inflammatory response in dry eye","volume":"59","author":"Yamaguchi","year":"2018","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B39","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1186\/s40001-025-02607-2","article-title":"Characterization of T cells in the progression of dry eye disease using single-cell RNA sequencing in mice","volume":"30","author":"Zhang","year":"2025","journal-title":"Eur J Med Res"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2023.08.004","article-title":"TNF is a critical cytokine in age-related dry eye disease","volume":"30","author":"Kelagere","year":"2023","journal-title":"Ocul Surf"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1038\/mi.2009.5","article-title":"IL-17 disrupts corneal barrier following desiccating stress","volume":"2","author":"De Paiva","year":"2009","journal-title":"Mucosal Immunol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"37","DOI":"10.2147\/MNM.S107246","article-title":"Matrix metalloproteinase-9 in the pathophysiology and diagnosis of dry eye syndrome","volume":"4","author":"Pflugfelder","year":"2017","journal-title":"Metalloproteinases Med"},{"key":"B43","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/S0002-9440(10)62232-8","article-title":"Matrix metalloproteinase-9 knockout confers resistance to corneal epithelial barrier disruption in experimental dry eye","volume":"166","author":"Pflugfelder","year":"2005","journal-title":"Am J Pathol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1016\/j.ophtha.2017.07.010","article-title":"The pathophysiology of dry eye disease: what we know and future directions for research","volume":"124","author":"Pflugfelder","year":"2017","journal-title":"Ophthalmology"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2407648121","article-title":"CD4+ T cells drive corneal nerve damage but not epitheliopathy in an acute aqueous-deficient dry eye model","volume":"121","author":"Vereertbrugghen","year":"2024","journal-title":"Proc Natl Acad Sci USA"},{"key":"B46","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1186\/s12974-019-1656-4","article-title":"Chronic dry eye induced corneal hypersensitivity, neuroinflammatory responses, and synaptic plasticity in the mouse trigeminal brainstem","volume":"16","author":"Fakih","year":"2019","journal-title":"J Neuroinflamm"},{"key":"B47","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/B978-0-323-82753-9.00001-1","volume-title":"Dry eye disease","author":"Chen","year":"2023"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2011.26.7.938","article-title":"Interleukin-17 in various ocular surface inflammatory diseases","volume":"26","author":"Kang","year":"2011","journal-title":"J Korean Med Sci"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1038\/s41385-022-00551-6","article-title":"Mucosal immunology of the ocular surface","volume":"15","author":"de Paiva","year":"2022","journal-title":"Mucosal Immunol"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.4103\/0974-620X.83653","article-title":"A review on recent advances in dry eye: pathogenesis and management","volume":"4","author":"Bhavsar","year":"2011","journal-title":"Oman J Ophthalmol"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1016\/j.exer.2020.108115","article-title":"Biological functions of tear film","volume":"197","author":"Pflugfelder","year":"2020","journal-title":"Exp Eye Res"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.18240\/ijo.2022.05.01","article-title":"Hyperosmolarity disrupts tight junction via TNF-\u03b1\/MMP pathway in primary human corneal epithelial cells","volume":"15","author":"Zhang","year":"2022","journal-title":"Int J Ophthalmol"},{"key":"B53","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1186\/s12974-023-02800-2","article-title":"An ocular Th1 immune response promotes corneal nerve damage independently of the development of corneal epitheliopathy","volume":"20","author":"Vereertbrugghen","year":"2023","journal-title":"J Neuroinflamm"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.17-23363","article-title":"High-mobility group box 1 in dry eye inflammation","volume":"59","author":"Lema","year":"2018","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0000000000001802","article-title":"Impact of low humidity on damage-associated molecular patterns at the ocular surface during dry eye disease","volume":"98","author":"Alven","year":"2021","journal-title":"Optom Vis Sci"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.66.4.28","article-title":"KGF-2 alleviates dry eye disease by regulating the HMGB1\/TLR4 pathway","volume":"66","author":"Wang","year":"2025","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B57","doi-asserted-by":"publisher","first-page":"9596","DOI":"10.1038\/s41598-019-46116-9","article-title":"Pro-inflammatory role of NLRP3 inflammasome in experimental sterile corneal inflammation","volume":"9","author":"Shimizu","year":"2019","journal-title":"Sci Rep"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.3390\/biology13090669","article-title":"Cellular stress in dry eye disease\u2014key hub of the vicious circle","volume":"13","author":"van Setten","year":"2024","journal-title":"Biology"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.18240\/ijo.2022.05.20","article-title":"Inflammation and dry eye disease-where are we","volume":"15","author":"Rao","year":"2022","journal-title":"Int J Ophthalmol"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1111\/aos.13436","article-title":"Clinical impact of inflammation in dry eye disease: proceedings of the ODISSEY group meeting","volume":"96","author":"Baudouin","year":"2018","journal-title":"Acta Ophthalmol"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1007\/s40123-025-01161-8","article-title":"Dry eye disease: From causes to patient care and clinical collaboration\u2014a narrative review","volume":"14","author":"Aragona","year":"2025","journal-title":"Ophthalmol Ther"},{"key":"B62","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2015.10.004","article-title":"The matrix metalloproteinase 9 point-of-care test in dry eye","volume":"14","author":"Lanza","year":"2016","journal-title":"Ocul Surf"},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/2415867","article-title":"High levels of 17\u03b2-estradiol are associated with increased matrix metalloproteinase-2 and metalloproteinase-9 activity in tears of postmenopausal women with dry eye","volume":"2016","author":"Shen","year":"2016","journal-title":"J Ophthalmol"},{"key":"B64","doi-asserted-by":"publisher","DOI":"10.1167\/tvst.7.5.31","article-title":"Matrix metalloproteinase 9 point-of-care immunoassay result predicts response to topical cyclosporine treatment in dry eye disease","volume":"7","author":"Park","year":"2018","journal-title":"Transl Vis Sci Technol"},{"key":"B65","doi-asserted-by":"publisher","DOI":"10.5662\/wjm.v15.i4.101033","article-title":"Diagnostic methods for managing dry eyes","volume":"15","author":"Musa","year":"2025","journal-title":"World J Methodol"},{"key":"B66","doi-asserted-by":"publisher","DOI":"10.3390\/ijms26178556","article-title":"Translating biomarker discovery: From bench to bedside in dry eye disease","volume":"26","author":"Jones","year":"2025","journal-title":"Int J Mol Sci"},{"key":"B67","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtos.2015.12.007","article-title":"Dry eye profiles in patients with a positive elevated surface matrix metalloproteinase 9 point-of-care test versus negative patients","volume":"14","author":"Lanza","year":"2016","journal-title":"Ocul Surf"},{"key":"B68","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2016.02.044","article-title":"A clinical trial comparing the safety and efficacy of topical tacrolimus versus methylprednisolone in ocular graft-versus-host disease","volume":"123","author":"Abud","year":"2016","journal-title":"Ophthalmology"},{"key":"B69","doi-asserted-by":"publisher","DOI":"10.4103\/IJO.IJO_2818_22","article-title":"Role of topical and systemic immunosuppression in aqueous-deficient dry eye disease","volume":"71","author":"Kate","year":"2023","journal-title":"Indian J Ophthalmol"},{"key":"B70","doi-asserted-by":"publisher","first-page":"3","DOI":"10.4103\/2211-5056.369606","article-title":"Dry eye disease: A review of anti-inflammatory therapies","volume":"13","author":"Nguyen","year":"2023","journal-title":"Taiwan J Ophthalmol"},{"key":"B71","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14155347","article-title":"Topical use of tacrolimus in corneal and ocular surface pathologies: A systematic review","volume":"14","author":"Katonis","year":"2025","journal-title":"J Clin Med"},{"key":"B72","doi-asserted-by":"publisher","DOI":"10.1080\/09513590400027257","article-title":"Menopause and dry eye. A possible relationship","volume":"20","author":"Versura","year":"2005","journal-title":"Gynecol Endocrinol"},{"key":"B73","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2016-309498","article-title":"The effects of transdermal testosterone and oestrogen therapy on dry eye in postmenopausal women: a randomised, placebo-controlled, pilot study","volume":"101","author":"Golebiowski","year":"2017","journal-title":"Br J Ophthalmol"},{"key":"B74","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.11-9110","article-title":"PDE4 inhibition suppresses IL-17-associated immunity in dry eye disease","volume":"53","author":"Sadrai","year":"2012","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"B75","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10184248","article-title":"The role of neuropeptides in pathogenesis of dry eye","volume":"10","author":"Hwang","year":"2021","journal-title":"J Clin Med"},{"key":"B76","doi-asserted-by":"publisher","DOI":"10.1007\/s40123-023-00861-3","article-title":"Analysis of clinical characteristics and neuropeptides in patients with dry eye with and without chronic ocular pain after FS-LASIK","volume":"13","author":"Zhao","year":"2024","journal-title":"Ophthalmol Ther"},{"key":"B77","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-021-01680-3","article-title":"A phase II, multicenter, randomized, placebo-controlled, double-masked trial of a topical estradiol ophthalmic formulation in postmenopausal women with moderate-to-severe dry eye disease","volume":"38","author":"Schmidl","year":"2021","journal-title":"Adv Ther"},{"key":"B78","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.jtos.2025.06.002","article-title":"A pilot randomized controlled trial of topical androgen treatment in dry eye","volume":"38","author":"Jiang","year":"2025","journal-title":"Ocul Surf"},{"key":"B79","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11164889","article-title":"The impact of probiotics and prebiotics on dry eye disease signs and symptoms","volume":"11","author":"Tavakoli","year":"2022","journal-title":"J Clin Med"},{"key":"B80","doi-asserted-by":"publisher","DOI":"10.1136\/bmjophth-2021-000956","article-title":"Microbiome and immune-mediated dry eye: a review","volume":"7","author":"Watane","year":"2022","journal-title":"BMJ Open Ophthalmol"},{"key":"B81","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1186\/s12886-024-03526-2","article-title":"What is the impact of microbiota on dry eye: a literature review of the gut-eye axis","volume":"24","author":"Song","year":"2024","journal-title":"BMC Ophthalmol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1732320\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T05:19:21Z","timestamp":1774588761000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1732320\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":81,"alternative-id":["10.3389\/fimmu.2026.1732320"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1732320","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"article-number":"1732320"}}