Plastics are synthetic materials made from organic polymers that are ubiquitous in daily living and are especially important in the healthcare setting. However, recent advances have revealed the pervasive nature of microplastics, which are formed by degradation of existing plastic products. Although the impact on human health has yet to be fully characterised, there is increasing evidence that microplastics can trigger inflammatory damage, microbial dysbiosis, and oxidative stress in humans. Although there are limited studies investigating their effect on the ocular surface, studies of microplastics on other organs provide some insights. The prevalence of plastic waste has also triggered public outcry, culminating in the development of legislation aimed at reducing microplastics in commercial products. We present a review outlining the possible sources of microplastics leading to ocular exposure, and analyse the possible mechanisms of ocular surface damage. Finally, we examine the utility and consequences of current legislation surrounding microplastic regulation.

Diquafosol sodium is a purinergic P2Y₂ receptor agonist that is garnering much interest for its potential therapeutic benefits in ocular surface management. This review provides a comprehensive analysis of diquafosol’s pharmacology, clinical effectiveness, and role in the evolving landscape of ocular surface management. Future research should focus on optimising formulations, treatment duration, and exploring potential combination therapies to maximise therapeutic outcomes. By targeting underlying pathophysiological mechanisms, diquafosol represents a significant advancement in ocular surface management and a valuable addition to existing therapies.

Background: There is increasing evidence that microplastics exert harmful effects on human health and on the ocular surface. This pilot study aims to investigate if microplastic particles are present in commonly used eyedrops in single-use plastic vials. Methods: Six commonly used commercial tear-replacement solutions available without a doctor’s prescription were tested (Brands A-F). All brands of eyedrops were analysed visually using light microscopy and the number of microplastic particles were manually counted. These were further analysed using the Agilent 8700 Laser Direct Infrared (LDIR) chemical imaging system. Results: All eyedrops analysed contained microplastics. The number of particles identified using light microscopy ranged between 15 (Brand E) to >18,000 (Brand F). In total, nine types of microplastics were identified with LDIR – polyethylene, polypropylene, polystyrene, polyvinylchloride, polyethylene terephthalate, polycarbonate, polymethylmethacrylate, polyamide and polyurethane. Conclusions: This study provides the most extensive quantification of microplastic contamination in commercial eyedrops to date, highlighting a major, under-recognised source of ocular exposure. These particles may arise from secondary degradation of plastic vials during production, transportation, storage, or during instillation, or introduced from other sources during production and represent a major source of exposure to the ocular surface, especially among patients who require chronic instillation of eyedrops.

There is growing interest in the application of Rho-associated protein kinase (ROCK) inhibitors (ROCKI) to the treatment of corneal diseases. ROCK is a key regulator of several cellular processes in the cornea, including cytoskeletal organization, cell proliferation, migration, inflammation, and wound healing. ROCKI, such as ripasudil and netarsudil, enhances endothelial cell migration, and promotes repair in conditions characterized by endothelial dysfunction. These agents also exert anti-inflammatory, anti-angiogenic, and anti-fibrotic effects for wound healing. As such, ROCKI demonstrate promise as therapeutic options for conditions such as Fuchs’ endothelial corneal dystrophy, pseudophakic bullous keratopathy, and iridocorneal endothelial syndrome. Emerging data further supports ROCKI’s potential in managing corneal neovascularization and supporting recovery following cataract surgery and keratoplasty, reducing the need for donor tissue. This narrative review provides a comprehensive evaluation of ROCKI’s mechanism of action, pharmacological properties, safety profile, applications in corneal disease management, emerging clinical trials, and novel approaches. We emphasize both preclinical and clinical findings, highlight existing evidence gaps, and outline future research priorities.