Next-generation dry eye therapies with Rahul Tonk, MD, MBA

Rahul Tonk, MD, MBA attended Envision Summit 2026 to present on refractive surgery, dry eye, and ocular surface disease. In the CE Spotlight Symposium titled “Emerging Therapeutic Advancements in Dry Eye Disease Management,” Tonk presented alongside Zeba Syed, MD; Aaleya Koreishi, MD; and Jade Coats, OD, FAAO, to emphasize that dry eye disease is increasingly viewed as a spectrum condition. In his segment of the session, Tonk referenced updates from TFOS DEWS III that promote standardized screening tools such as the OSD-6 questionnaire to enable earlier detection and better disease stratification. He sat down with the Eye Care Network to detail the latest developments in dry eye.

Tell us a little about yourself and why came to Envision Summit 2026.

Rahul Tonk, MD, MBA: I’m a cornea, cataract, and refractive surgeon at the Princeton Eye Group in Princeton, New Jersey, and an associate professor of ophthalmology at Wills Eye Hospital. I was pleased to attend the Envision Summit 2026 to present on refractive surgery, dry eye, and ocular surface disease. It’s a fantastic conference with strong educational programming and a great sense of community.

What emerging treatments in dry eye disease are most promising, and how are they shaping your approach?

Tonk: The dry eye space continues to evolve rapidly. We discussed the updated TFOS DEWS III report, which reinforces that dry eye is a spectrum disease and emphasizes improved screening tools, including the OSD-6 questionnaire. Standardizing screening helps us identify patients earlier and stratify disease more effectively. In terms of therapies, Transient Receptor Potential Melastatin 8 [or TRYPTYR]—a TRPM8 receptor agonist—has been exciting. It stimulates basal tear secretion and may also provide benefit for certain neuropathic pain patients due to its cooling sensation. Another newer option is Miebo (perfluorohexyloctane ophthalmic solution), which acts as an evaporation shield and can be used alongside immunomodulators and anti-inflammatory therapies. We are fortunate to have multiple mechanisms of action available. That allows us to be far more targeted in how we manage ocular surface disease.

How do you determine when to incorporate newer therapies versus relying on established treatments?

Tonk: I focus on four main factors: clinical trial data, efficacy, safety and tolerability, and patient access. It’s important not only that a therapy works, but that patients can obtain and use it comfortably. I think in categories. Are we treating inflammation? Stimulating tear production—such as with varenicline nasal spray or TRYPTYR? Addressing evaporative loss? Or targeting external contributors like Demodex blepharitis? By identifying the primary driver of symptoms, we can move beyond a generalized “dry eye” diagnosis and treat the underlying mechanism more precisely. That more surgical, individualized approach has significantly improved outcomes in my practice.

Looking ahead, what breakthroughs may most improve quality of life for patients with chronic dry eye?

Tonk: One promising therapy is reproxalap, a RASP inhibitor that may soon receive FDA clearance. What’s compelling about it is that it may work upstream of topical steroids and other immunomodulators, potentially offering faster relief of inflammation. I’m also enthusiastic about qualified autologous serum tears available through Ocubio. These are carefully processed and quality-controlled and can be stored at room temperature, which improves convenience and accessibility. Looking further ahead, the potential for allogeneic serum therapies could represent another major step forward. Overall, expanding anti-inflammatory options and improving biologic tear therapies will likely have a meaningful impact on both symptom relief and long-term ocular surface health.