Immunopathogenesis And Regenerative Management Of Autoimmune Ocular Surface Disease

To review current molecular mechanisms underlying autoimmune ocular surface disease and to highlight emerging therapeutic strategies aimed at restoring ocular surface integrity and visual function.

Department of Ophthalmology, Medical University of Silesia, Katowice, Poland; Professor K. Gibiński University Clinical Center, Katowice, Poland.

A narrative review of recent molecular, translational, and clinical studies investigating autoimmune disorders affecting the ocular surface, particularly systemic lupus erythematosus, primary Sjögren’s syndrome, and ocular cicatricial pemphigoid. The analysis focuses on immunologic pathways responsible for ocular surface damage, including cytokine signaling, complement activation, oxidative stress, and epithelial–mesenchymal transition. In addition, emerging pharmacologic, regenerative, and surgical approaches targeting ocular surface restoration were evaluated.

Autoimmune ocular surface diseases involve chronic inflammation leading to epithelial dysfunction, tear film instability, and tissue remodeling. Shared molecular pathways—including dysregulation of IFN-I, IL-6, and IL-17 signaling, complement activation, and oxidative stress—contribute to epithelial injury and fibrosis. Advances in molecular profiling have enabled identification of biomarkers linked to ocular surface inflammation and progression. Emerging therapies include targeted biologics modulating BAFF, interferon receptors, and JAK/STAT signaling, as well as regenerative approaches such as mesenchymal stem cells, platelet-rich plasma, and amniotic membrane transplantation to suppress inflammation and restore ocular surface function.

Autoimmune diseases affecting the ocular surface represent a complex spectrum of disorders in which systemic immune dysregulation leads to localized epithelial damage and progressive ocular surface failure. Advances in molecular immunology and regenerative ophthalmology are shifting treatment paradigms toward precision immunomodulation and tissue regeneration. Integrating targeted biologic therapy with regenerative surgical strategies may offer new opportunities for restoring ocular surface homeostasis and improving visual outcomes.