DPP4 and dry eye syndrome: Case reports have demonstrated a reduction in the rate of DR with dipeptidyl peptidase-4 (DPP-4) inhibitors; nevertheless, their use for less than a year may lead to an early progression of DR.84,85 Lately, DPP-4 inhibitors (saxagliptin and vildagliptin) have been associated with the manifestation of cicatricial pemphigoid, a toxic reaction to drugs that leads to severe dry eye.86 Abnormal scarring is the hallmark of mucous membrane pemphigoids lesions heal via a fibrosing process, resulting in cicatricial lesions that can cause severe impairment of the eyes.