Autologous Serum Tears With Hyaluronate vs Balanced Salt Solution for Moderate-to-Severe Dry Eye

Inclusion Criteria: * Age ≥ 18 years old * Formal diagnosis of one of the following conditions associated with aqueous-deficient dry eye disease: Sjögren's syndrome (primary or secondary), Mucous membrane pemphigoid, Graft-versus-host disease, Stevens-Johnson syndrome, Post-radiation lacrimal gland aqueous deficiency, or Neurotrophic keratitis * Moderate-to-severe Dry Eye Disease (DED) symptoms for at least 6 months prior to study enrollment. * OSDI score ≥ 25 and/or and OSDI-6 score \> 6 at the screening visit * Presence of at least two of the following clinical signs in the same eye, at the screening visit: Anesthetized Schirmer's test score 7 ≤ mm at 5 minutes, Tear Break up Time (TBUT) ≤ 7 seconds, Corneal fluorescein staining score ≥ 4 (maximum 15) as assessed by the National Eye Institute (NEI) grading scale 25, or Conjunctival lissamine green staining ≥ 3 (maximum 18) as assessed by the NEI grading scale * Desire to use autologous serum tears at least twice daily in the 2 weeks prior to screening visit. Exclusion Criteria: * Age \<18 years old. * Cognitive impairment or psychiatric condition that precludes informed consent or the ability to comply with study procedures. * Any clinical condition identified at screening that, in the opinion of the treating physician, is clinically significant and would contraindicate safe participation in the study. * Any condition or treatment known to affect the signs and symptoms of DED, including pregnancy, regul…