Dry eye disease (DED) is a multifactorial disease of tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability, which can lead to damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface 1. Symptoms associated with DED are burning, stinging, grittiness, foreign body sensation, tearing, ocular fatigue, and dryness 2,3. The two main causes of DED are reduced tear production by the tear secretion gland, and excessive evaporation of the tear film 4. In patients with autoimmune diseases such as Sjogren syndrome, systemic lupus erythematosus and rheumatoid arthritis, immune damage to meibomian glands reduces expression of lipids
