The number and quality of tears that lubricate and protect the eyes are affected by the common eye ailment known as dry eye. If the eyes do not generate enough tears or if they evaporate too quickly, the eyes become dry, irritated, and uncomfortable. Dryness, burning, itching, redness, and impaired vision are typical signs and symptoms of dry eye. Anyone can get dry eye syndrome regardless of age or gender, but older persons, particularly women, are more likely to do so1. Certain medications, such as antihistamines and antidepressants, medical conditions such as diabetes and rheumatoid arthritis, environmental factors such as low humidity and wind exposure, and prolonged use of digital devices such as computers can increase the risk of developing dry eye2. Depending on the research population and the diagnostic methods used, the prevalence of dry eye illness is thought to vary from 5% to 50% worldwide3. The global prevalence of dry eye disease is estimated to be 11.59 percent4.

PRP therapy is utilized in the context of dry eye conditions with the objective of stimulating the meibomian glands and augmenting tear production. The meibomian glands play a crucial role in the synthesis of the lipid component of the tear film, which functions to reduce excessive evaporation of tears5. Through the topical application or injection of PRP in the affected region, the concentrated platelets and growth factors have the potential to induce the production and secretion of meibum6. Consequently, this process can enhance the functionality of the meibomian glands and reinstate stability to the tear film.

The therapeutic benefits of PRP extend beyond the stimulation of tear production. PRP is composed of multiple growth factors that possess the ability to mitigate inflammation and facilitate the process of tissue regeneration, thereby playing a significant role in enhancing the overall well-being of the ocular surface7. Moreover, it has been demonstrated in previous studies that PRP therapy can effectively improve the structural integrity of the meibomian glands8. This enhancement may have the potential to mitigate the development of complications that arise from untreated meibomian gland dysfunction, including corneal ulcers and infections.

With the increasing incidence of dry eye3, there is an increasing imperative to explore innovative treatment modalities, such as PRP therapy, that present promising strategies for the effective management of this particular condition. PRP therapy presents a viable and potentially advantageous method for addressing the root causes of dry eye and enhancing the health of the ocular surface by harnessing the regenerative capabilities inherent in the patient's own blood.

In the subsequent sections of this review article, an in-depth analysis will be conducted on the clinical evidence that substantiates the utilization of PRP therapy for the treatment of meibomian gland dysfunction and dry eyes. This examination will encompass an evaluation of the outcomes derived from pertinent studies, as well as a comprehensive discussion of the potential advantages and considerations associated with this emerging therapeutic approach.

Effective management of dry eye necessitates the diagnosis and treatment of MGD48. MGD is widely recognized as the primary cause of evaporative dry eye, constituting the predominant underlying factor in most cases of dry eye. Thus, the recognition and resolution of MGD in individuals with dry eye are imperative for restoring meibomian gland functionality and enhancing the general well-being of the ocular surface49. A range of diagnostic tools can be employed in the assessment of ocular health. For instance, meibography utilizes advanced imaging technology to provide a visual representation of the meibomian glands. Additionally, non-invasive tear film break-up time (NIBUT) is used to evaluate the stability of the tear film. The tear film has been extensively studied42.

The current standard of care for treating MGD primarily includes warm compress therapy, eyelid hygiene, and various advanced treatments such as intense pulsed light (IPL) therapy and thermal pulsation. While these methods can provide symptom relief and improve ocular surface health, they also have notable disadvantages. Warm compresses are primarily palliative, offering temporary relief rather than a cure50. There is no consensus on the optimal application method or duration, leading to inconsistent patient outcomes50. Other procedures like meibomian gland probing and thermal pulsation can be invasive and expensive, limiting accessibility for some patients51. While combined therapies (such as intense pulsed light combined with meibomian gland probing) show promise, not all combinations yield significant improvements52. Regarding pharmacological treatments, some patients may develop allergies to ingredients in eyelid hygiene products, complicating treatment51. Topical steroids, while effective, carry risks of glaucoma and cataracts with prolonged use51.

Despite these challenges, ongoing research into tailored approaches and emerging therapies may enhance treatment efficacy and patient satisfaction in managing MGD. Recent research has indicated that PRP could potentially serve as a viable therapeutic approach for restoring meibomian gland function in individuals suffering from MGD8, 53, 54. PRP is composed of growth factors and various healing agents, which have the potential to facilitate tissue regeneration and repair, resulting in enhanced meibomian gland structure and function54.

Healthcare providers could enhance dry eye management and alleviate symptoms in patients with dry eye by accurately diagnosing and effectively treating MGD. Ultimately, the implementation of this intervention has the potential to enhance patients' quality of life and mitigate the risk of complications that may arise from untreated MGD, including corneal ulcers, infections, and visual impairment53.

Using the patient's own blood, the regenerative medicine procedure known as PRP therapy promotes tissue regeneration and healing54, 55. A small sample of the patient's blood is drawn for this procedure, which is subsequently processed to concentrate platelets and other growth factors important for tissue repair and regeneration55. The obtained blood is first centrifuged to separate the various components before being made into PRP. Platelets and plasma, which contain growth factors and other healing agents, are separated from red and white blood cells. After that, platelets and plasma are further treated to concentrate them and boost their potency56, 57.

Platelets, plasma, and growth factors are concentrated to create the PRP solution, which can be injected or applied topically to the affected area58. PRP's high platelet and growth factor concentration encourages tissue regeneration, reduces inflammation, and accelerates the healing process59. PRP therapy has been applied in a number of medical specialties, including dermatology55 and orthopedics60, 61. In ophthalmology, PRP therapy has been demonstrated to be useful in treating meibomian gland dysfunction and other ocular surface conditions8, 62. It is believed that the growth factors in PRP encourage cell regeneration, reduce inflammation, and increase meibum production and secretion, which may aid in restoring meibomian gland function and alleviating the symptoms of dry eyes8. With these encouraging findings, several studies have investigated the use of PRP for meibomian gland dysfunction and dry eyes.

Clinical research regarding the efficacy of PRP therapy in managing DED and MGD has revealed significant enhancements in both symptomatology and tear film metrics, particularly in individuals who exhibit resistance to conventional therapeutic modalities. Investigations concerning the application of PRP eye drops for evaporative dry eye disease have indicated marked alleviation of symptoms and improvements in tear film stability, as evidenced by a Canadian Dry Eye Assessment score enhancement of -5.45 (p < 0.001) and superior non-invasive break-up times8. Comparative studies have evaluated the efficacy of PRP injections into the lacrimal gland, revealing significant improvements in non-invasive tear break-up time and Schirmer test scores when compared to control treatments using preservative-free eye drops63. In randomized clinical trials, PRP injections have demonstrated superior efficacy in enhancing corneal staining and tear parameters compared to hyaluronic acid treatments in patients with severe dry eye syndrome64. In assessments comparing autologous platelet-rich plasma (aPRP) to artificial tears, aPRP consistently resulted in more pronounced symptom relief, including a significant reduction in the Ocular Surface Disease Index (OSDI) by -22.7 (p < 0.001) and improved tear stability65. This efficacy is attributed to the elevated concentration of growth factors in PRP, such as fibroblast growth factor (FGF) and epidermal growth factor (EGF), which are crucial for ocular surface healing and the maintenance of tear film stability62. Notably, 93.3% of patients reported symptom improvement with PRP drops, in contrast to traditional artificial tears, which do not possess the complex, preservative-free formulation that PRP provides66. Patients with severe DED who received PRP injections and PRP eye drops experienced significant improvements in best-corrected visual acuity, Schirmer test scores, TBUT, and corneal staining. These treatments were well-tolerated, with no adverse reactions reported, further supporting the efficacy and safety profile of PRP66. A retrospective case series of patients treated with PRP for ocular surface disease demonstrated a statistically significant reduction in OSDI scores (from 39.5 to 30.8, p = 0.02). Additionally, there was a borderline increase in Schirmer test scores, and 14% of eyes showed improvement in conjunctival staining67.

Comparative studies involving autologous serum (AS) eye drops in patients with primary Sjögren’s syndrome have shown that PRP exhibits similar efficacy in alleviating the signs and symptoms of DED. However, PRP has the advantage of a quicker preparation time compared to AS, making it a more convenient and preferable alternative for treating dry eye in primary Sjögren’s syndrome68. A multicentric study on plasma rich in growth factors (PRGF) demonstrated significant reductions in corneal epithelial erosions and improvements in SANDE scores. Additionally, 74.3% of patients exhibited decreased corneal staining69.

Randomized studies comparing PRP to artificial tears containing sodium hyaluronate have shown that PRP yields superior outcomes in visual acuity and reduction of hyperemia, particularly in cases of moderate to severe DED70. PRP therapy has also been shown to be effective in alleviating chronic ocular surface syndrome following LASIK surgery, resulting in improvements in dry eye symptoms in 85% of cases and significant reductions in conjunctival hyperemia71. Furthermore, the application of immunologically safe plasma rich in growth factors (PRGF) for treating dry eye in patients with Sjögren’s syndrome has resulted in substantial symptom improvement, suggesting that PRGF is a safe and effective option for managing immune-mediated dry eye conditions72. These clinical findings highlight the potential of PRP as a therapeutic option for dry eye, especially in cases resistant to conventional treatments. Future research involving larger patient cohorts is necessary to refine treatment protocols and assess the long-term benefits of PRP across diverse DED populations.

Figure 1

DED, which arises from an imbalance in tear production or quality, manifests through symptoms such as irritation, visual disturbances, and damage to the ocular surface. MGD, a primary cause of evaporative DED, worsens this condition by disrupting lipid secretion, leading to faster tear evaporation and increased exposure of the ocular surface to environmental stressors. This interplay fosters a cycle of inflammation and cellular damage, highlighting the necessity for effective therapeutic interventions. One promising approach to interrupt this cycle is the use of PRP, an autologous blood derivative enriched with growth factors and anti-inflammatory cytokines. PRP has emerged as a potential treatment for ocular surface disorders due to its capacity to promote healing and reduce inflammation. This therapeutic strategy is particularly beneficial for patients with moderate to severe DED or MGD who do not respond to conventional treatments.

Numerous studies highlight the effectiveness of PRP in alleviating symptoms and promoting ocular surface health. For example, research involving patients with moderate DED unresponsive to other treatments revealed significant improvements following PRP therapy. Specifically, 80% of participants reported substantial symptom relief, as indicated by lower scores on the Ocular Surface Disease Index (OSDI). Additionally, objective measures such as tear break-up time (TBUT) and ocular staining scores (OSS) showed marked enhancement, with 85% of eyes exhibiting prolonged TBUT and 90% demonstrating reduced OSS scores. In hyperosmotic models, PRP was found to decrease the expression of pro-inflammatory mediators, including interleukin-1, tumor necrosis factor-alpha, and matrix metalloproteinases (MMP-1 and MMP-3), underscoring its anti-inflammatory capabilities at the cellular level73.

Inflammation is a pivotal factor in both DED and MGD. In MGD patients, meibomitis frequently causes conjunctival hyperemia, superficial punctate keratopathy (SPK), and neovascularization of the ocular surface. If the inflammatory response remains untreated, it can severely disrupt tear stability and ocular surface integrity, leading to tissue damage and worsening DED symptoms74. The anti-inflammatory properties of PRP, which include reductions in interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-α), and matrix metalloproteinases, make it a promising approach to mitigating these inflammatory processes. This positions PRP as a comprehensive treatment option for MGD and associated DED. PRP has demonstrated the ability to promote the differentiation of meibomian gland epithelial cells and enhance their proliferative capacity. For instance, PRP has been shown to enhance the levels of EGF, TGF-β, VEGF, and PDGF in the tear film of individuals diagnosed with DED resulting from MGD. The growth factors have the potential to initiate multiple signaling pathways, including the mitogen-activated protein kinase (MAPK), phosphatidylinositol 3-kinase (PI3K), and Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathways. These pathways play a crucial role in regulating various aspects of epithelial cell behavior, such as cell cycle progression, survival, migration, and differentiation75, 76. These modifications have the potential to facilitate the reestablishment of ocular surface homeostasis and integrity following PRP treatment.

By improving the function of the meibomian glands, PRP directly enhances the quality of the tear film and reduces ocular inflammation, significantly improving the condition of patients with MGD and DED77. PRP has been shown to reduce the level of apoptosis (programmed cell death) in meibomian gland epithelial cells. In research models, this reduction in apoptosis helps maintain the structure and function of the glands, thereby improving tear film stability and alleviating chronic inflammatory symptoms on the ocular surface78.

PRP also holds promise in the broader context of wound healing and angiogenesis. Research on PRP-derived exosomes has shown that sphingosine-1-phosphate (S1P), a lipid signaling molecule present in PRP, plays a crucial role in promoting angiogenesis and tissue repair through the S1PR1/AKT/FN1 signaling pathway. S1P and its associated signaling pathways have significant implications for enhancing blood flow and maintaining vascular homeostasis on the ocular surface. This can potentially alleviate tissue ischemia and promote healing in cases of severe DED with neovascularization79. Furthermore, research indicates that the stimulation of platelets by PRP through PAR-1 and PAR-4 receptors enhances the release of VEGF. This process promotes angiogenesis, which may help counteract the ocular surface damage observed in chronic DED and MGD80.

PRP shows significant promise as a treatment for moderate to severe DED and MGD. Its multifaceted approach—encompassing anti-inflammatory effects, support for cellular repair, and stimulation of angiogenesis—addresses the complex pathology of DED and MGD at various levels. As a blood-derived treatment, PRP is both practical and effective, offering patients an alternative when conventional therapies fail. Its potential for use in various storage conditions, ease of preparation, and notable efficacy in studies suggest that PRP could become a staple treatment for ocular surface diseases, significantly improving the quality of life for patients suffering from chronic DED and MGD.

The dysfunction of meibomian glands is a significant factor in the development of dry eye syndrome, which results in the impairment of tear film and the overall health of the ocular surface. Although conventional treatments provide relief for symptoms, there is ongoing research to find more efficient and durable solutions. The utilization of PRP therapy has emerged as a potentially effective therapeutic strategy for targeting the root causes of dry eye syndrome and reinstating the proper functioning of the meibomian glands.

Numerous clinical investigations have been conducted to assess the effectiveness of PRP therapy in individuals diagnosed with MGD and dry eye. The implementation of standardized techniques for the preparation of PRP and the establishment of consistent treatment protocols would significantly enhance the reproducibility and reliability of treatment outcomes.

Furthermore, it is necessary to conduct comparative studies that assess the efficacy of PRP therapy in comparison to currently available treatments and combination therapies. Moreover, additional investigation is required to delve into the fundamental mechanisms of PRP therapy in addressing meibomian gland dysfunction and dry eye, potentially paving the way for the advancement of novel and more comprehensively understood therapeutic approaches. As scientific inquiry advances and our comprehension of PRP therapy deepens, there arises the possibility of a paradigm shift in the management of dry eye syndrome, leading to substantial improvements in the well-being and overall quality of life for affected individuals.

aPRP: Autologous Platelet-Rich Plasma, AS: Autologous Serum, DED: Dry Eye Disease, EDE: Evaporative Dry Eye, EDED: Evaporative Dry Eye Disease, EGF: Epidermal Growth Factor, FGF: Fibroblast Growth Factor, IL-1: Interleukin-1, IL-10: Interleukin-10, JAK/STAT: Janus Kinase/Signal Transducer and Activator of Transcription, LASIK: Laser-Assisted in Situ Keratomileusis, MGD: Meibomian Gland Dysfunction, MAPK: Mitogen-Activated Protein Kinase, MMPs: Matrix Metalloproteinases, NIBUT: Non-Invasive Tear Film Break-Up Time, OSDI: Ocular Surface Disease Index, PDGF: Platelet-Derived Growth Factor, PI3K: Phosphatidylinositol 3-Kinase, PRGF: Plasma Rich in Growth Factors, PRP: Platelet-Rich Plasma, SANDE: Symptom Assessment in Dry Eye, TBUT: Tear Break-Up Time, TGF-β: Transforming Growth Factor-beta, TFLL: Tear Film Lipid Layer, TMH: Tear Meniscus Height, TNF-α: Tumor Necrosis Factor-alpha, VEGF: Vascular Endothelial Growth Factor

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All authors equally contributed to this work, read and approve the final proof for publication.

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The authors declare that they have no competing interests.