Clinical Comparison of Three Blood-Derived Eye Drop Formulations for Moderate-to-Severe Dry Eye Disease: A Prospective Comparative Study.

Introduction Dry eye disease (DED) is a multifactorial disorder of the ocular surface characterized by tear film instability, ocular discomfort, inflammation, and visual disturbance. Blood-derived eye drops have emerged as biologic therapeutic options for patients with moderate-to-severe DED because they contain growth factors and bioactive molecules that promote epithelial repair and restore ocular surface homeostasis. This study compared the short-term clinical performance and safety of autologous serum (AS), autologous platelet lysate (A-PL), and cord blood platelet lysate (CB-PL) eye drops. Methods This prospective randomized comparative study included 80 patients (160 eyes) with moderate-to-severe DED. Participants received AS (n = 20), A-PL (n = 20), or CB-PL (n = 40) for four weeks. Clinical evaluation included tear break-up time (TBUT), Oxford Grading Scale (OXFORD), Ocular Surface Disease Index (OSDI), Schirmer test, best-corrected visual acuity (VA), and intraocular pressure (IOP). Principal component analysis (PCA) was performed as an exploratory post hoc analysis to evaluate multidimensional treatment-response patterns. Results All three biologic formulations significantly improved TBUT, OXFORD score, and OSDI after four weeks of treatment. CB-PL demonstrated the largest median improvements across these clinical parameters, whereas A-PL showed intermediate improvement and AS produced clinically meaningful but comparatively smaller changes. No significant differences were observed among treatment groups for VA, Schirmer test, or IOP. No treatment-related adverse events, withdrawals, or protocol deviations occurred during follow-up. Conclusion All three blood-derived eye drop formulations improved both objective and subjective measures of DED after four weeks of treatment. CB-PL demonstrated the greatest magnitude of short-term clinical improvement in this cohort. These findings support the potential of platelet lysate-based therapies for patients with moderate-to-severe DED, although larger randomized studies with longer follow-up are needed to confirm these observations.