## 6 Strategic Planning and Risk Mitigation
### Artificial Tear Solutions  
The spacecraft environment, characterized by low humidity, altered airflow dynamics, and microgravity, exacerbates dry eye syndrome (DES), increasing the risk of micro-abrasions, inflammation, and secondary infections [32]. Artificial tear solutions with sustained-release formulations help maintain hydration and reduce application frequency, making them ideal for extended missions [32; 77]. However, fluid dynamics in microgravity can compromise the efficacy of traditional artificial tears, necessitating innovative approaches to maintain tear film stability [20; 36].  
Administering eye drops in microgravity presents unique challenges due to the behavior of liquids in a weightless environment. Surface tension prevents fluid from forming discrete droplets, leading to difficulties in controlled application [11]. Traditional dispensers may result in overdosing or medication waste [11]. To address this, NASA has collaborated with companies like Nanodropper to develop micro-volume dispensers that regulate ophthalmic drug delivery in space [78]. Additionally, alternative approaches, such as gel-basedartificial tears and pressurized dispensing systems, are under investigation to improve medication adherence during long-duration missions [79]. Understanding and optimizing these first-line treatment methods are essential before considering more advanced corneal interventions, such as bioengineered tear substitutes and regenerative therapies.  
Recent advancements include gel-based artificial tears and bioengineered tear replacements designed to mimic the natural tear film. Formulations enriched with hyaluronic acid provide enhanced lubrication and protection. High molecular weight (HMW) hyaluronic acid, in particular, reduces oxidative stress, exhibits anti-inflammatory properties, and improves tear retention, making it highly effective for managing DES in extreme environments [80; 81]. Lipid-based formulations address evaporative dry eye by stabilizing the lipid layer and reducing tear evaporation, crucial for mitigating microgravity-induced tear film instability [81].  
Nanoparticle-based tear substitutes represent a promising frontier in DES management. These advanced systems prolong hydration and incorporate antimicrobial and anti-inflammatory agents, directly addressing the increased risks of infection and irritation in microgravity [34]. Complementary technologies, such as neurostimulation devices like intranasal stimulators, promote endogenous tear production and maintain tear film homeostasis without reliance on gravity-dependent application methods [82].  
The integration of anti-inflammatory agents or antimicrobial peptides into artificial tear formulations further enhances their efficacy by targeting the underlying causes of ocular surface damage. These formulations also support wound healing, a critical feature given the heightened risk of corneal abrasions in particulate-laden environments like lunar or Martian missions [20].  
While artificial tear solutions remain a cornerstone of ocular health management during space missions, their incorporation into comprehensive preventive and therapeutic frameworks--including protective eyewear, telemedicine systems, and AI-driven diagnostics--ensures a robust approach to mitigating ocular risks. Together, these innovations safeguard astronaut health and contribute to the success of missions in challenging extraterrestrial environments.