Therapeutic Potential of Mesenchymal Stem Cell–Derived Exosomes in Ocular Surface Disorders

The global burden of ocular surface disorders (OSDs), manifesting as progressive visual impairment and chronic discomfort, has driven urgent exploration of regenerative therapeutic strategies. Mesenchymal stem cell-derived exosomes (MSC-Exos) have emerged as promising candidates for OSD treatment, as they exhibit multifaceted therapeutic properties including immunomodulation, antifibrotic activity, and pro-regenerative capacity. This systematic review consolidates current understanding of MSC-Exo-mediated ocular surface repair mechanisms, with particular emphasis on the molecular dialog established through delivery of bioactive cargo that modulate pivotal signaling pathways. We critically analyze preclinical evidence demonstrating therapeutic efficacy across diverse OSD pathologies, including dry eye disease, corneal epithelial defects, and limbal stem cell deficiency. Notwithstanding these advances, critical barriers to clinical translation persist: (1) methodological heterogeneity arising from variable cell sourcing, culture protocols, and exosome isolation/characterization standards; (2) discordance between animal models and human OSD pathophysiology; and (3) technological limitations in scalable, clinically compatible delivery systems. Addressing these challenges requires interdisciplinary collaboration to standardize exosome production pipelines and establish robust preclinical validation frameworks, thereby accelerating the transition of MSC-Exo therapies from bench to bedside.