Professor Christophe Baudouin et al. recently published an interesting update on DED: "Revisiting the vicious circle of dry eye disease: a focus on the pathophysiology of meibomian gland dysfunction".
With it being an open access article, all the content is freely available.
Here is a short excerpt:
"The vicious circle scheme allows us to understand why, once the cycle is initiated, the continuous environmental challenge acting on a compromised ocular surface allows the vicious circle to perpetuate, even if the initial cause has been removed or reduced (figure 2).3 The vicious circle scheme may also promote the development of therapeutic strategies that can simultaneously target the multiple mechanisms underlying the pathophysiology of DED.30 For example, tear substitutes with osmoprotective properties3 31–33 may act on multiple points to break the vicious circle of DED.3 33 34 "