1 · Growth factors & blood derivatives
Topical insulin (eye drops)
Review — modulators of corneal healing › 1 · Growth factors & blood derivatives › Topical insulin (eye drops)
Topical insulin (eye drops)
Regular human insulin diluted in artificial tears / physiological saline · repurposing of an old molecule
Oxford II–IV
Weak–Moderate · emerging
Present-emerging
Mechanism of actionBinding to epithelial insulin and IGF-1 receptors → PI3K/Akt and MAPK pathways → epithelial proliferation, migration and metabolic support; support of nerve function. Strong rationale in the diabetic/neurotrophic cornea.
IndicationsRefractory PED (diabetic, neurotrophic), post-surgery (post-vitrectomy), dry eye — often 2nd line when serum and conventional measures fail.
Route & dosageTopical, ~1 IU/mL (protocols 1–100 IU/mL), generally ~4×/day until closure (days to weeks). Refrigerated; not standardized.
Level of evidenceOxford II–IV / GRADE very low–low but improving · Scale: Weak–Moderate (emerging). Consistent positive signals in refractory PED, low cost, good tolerability.
| FDA | No for the eye — insulin approved for diabetes; ocular use off-label / compounded. |
|---|---|
| EU MA | No for the eye — off-label. |
| France | Off-label / hospital preparation. |
| USA | Off-label, compounded. |
| Asia | Off-label use reported (India, others). |
Key studies: Abdi et al., topical insulin for refractory PED (Sci Rep 2024) — PMID 38816428; systematic review, Graefe's Arch Clin Exp Ophthalmol 2025 — PMID 40381039; meta-analysis + GRADE (2025) — PMID 41658257.
See also: Gabison E. “Corneal wound-healing agents”. In: SFO 2023 Report — Médicaments et biothérapies en ophtalmologie, chapter 21. Full text, open access (in French).