Diagnosis and Management of Dry Eye Disease/Syndrome: Consensus of Experts from Russia, Kazakhstan, Uzbekistan and Belarus (Samarkand, 2026)

Dry eye disease/syndrome (DED) is a common multifactorial disorder of the ocular surface characterized by disruption of tear film homeostasis, inflammation, ocular surface damage, and neurosensory abnormalities. Despite the availability of international recommendations, differences in healthcare systems and clinical practice across Eastern Europe and Central Asia necessitate adaptation of diagnostic and therapeutic approaches. The aim of this expert consensus was to summarize the participating experts’ perspectives on the diagnosis, treatment, and monitoring of DED in the healthcare settings represented by Belarus, Kazakhstan, Russia, and Uzbekistan. The expert meeting was held on 28 March 2026 in Samarkand, Uzbekistan, and involved 12 ophthalmologists from the four countries, as well as invited experts from the United Kingdom and Poland. The recommendations were formulated based on discussion of clinical issues, case reviews, electronic voting, and analysis of current evidence. Through the described consensus process, the participating experts proposed a minimum diagnostic workup and a stepwise treatment framework based on disease severity and predominant pathophysiological mechanisms. The participating experts identified tear replacement therapy as a component of the proposed treatment framework. For patients with persistent inflammation, the participating experts discussed the potential role of anti-inflammatory therapy within the proposed treatment framework. The participating experts discussed the potential role of anti-inflammatory therapies, including cyclosporine A, for moderate-to-severe disease and considered circumstances in which combination treatment may be used. The participating experts proposed consensus-based criteria for assessing treatment response, considering treatment escalation, and referring patients to other specialists. The consensus identified common regional barriers, including limited consultation time, inadequate access to diagnostic tools, economic constraints, and insufficient multidisciplinary referral pathways. The discussion also addressed long-term follow-up and potential approaches for evaluating the proposed recommendations in the represented healthcare settings.