Figure 1.

Oxidative metabolism and changes in normal microbiota contribute to dry eye disease (DED) by inducing inflammation at the ocular surface. Reactive oxygen species (ROS) directly or indirectly activates the NLRP3 inflammasome by increasing tear-film instability and osmolarity. DED-associated changes in the microbiota is in turn associated with changes in the metabolic profile of the ocular surface which changes the balance between pro- and anti-inflammatory arms of the immune system toward the proinflammatory pathways. The induced inflammation is presumably the cornerstone of DED pathology. Abbreviations: DED: dry eye disease, FoxO3: Forkhead box O3, LPS: lipopolysaccharide, MnSOD: manganese superoxide dismutase, NLRP3: NLR family pyrin-domain-containing 3, ROS: reactive oxygen species, Sirt1: sirtuin 1, SOD: superoxide dismutase, Treg: regulatory T-cell.