Introduction
disorder of the ocular surface, Dry eye syndrome
PATHOPHYSIOLOGY, DRY EYE SYNDROME
Dry eye syndrome (DES) is a disorder of the ocular surface, frequently characterized by lipid or aqueous deficiency of the tear film.One potential factor mediating the inflammatory pathophysiology of DES is the ocular surface microbiome (OSM), composed of all microbial flora colonizing the ocular surface.Artificial tears (ATs) are a mainstay of DES therapy.Given the widespread use of CMC-ATs and its potential implications for the OSM, we conducted a double-masked randomized controlled trial examining the effects of CMC-ATs on the OSM and DES symptoms, compared to a control PEG-AT without CMC. Outcomes included metagenomic analysis of the OSM by 16S bacterial ribosomal RNA (rRNA) sequencing,