Dry eye disease (DED) is a multifactorial condition of the ocular surface and tear film characterized by the loss of tear film homeostasis. It affects 5 percent to 50 percent of the adult population globally, with a prevalence of 29.5 percent to 39.62 percent reported in India . Moderate to severe DED can impair daily activities, social functioning, and quality of life . If left untreated, it may lead to chronic corneal epithelial damage, ulceration, and even vision loss or functional blindness in rare cases. Artificial tears remain the mainstay of conventional DED therapy, offering only temporary symptom relief without addressing the underlying inflammation. Cyclosporine A (CsA), an immunomodulatory agent, reduces ocular surface inflammation and promotes tear production. The FDA has approved 0.05 percent topical CsA for moderate to severe DED. RCTs have demonstrated its efficacy over vehicle in improving Schirmer scores and reducing corneal staining. It is considered safe and effective for patients not responding to artificial tears alone. Recent meta-analyses suggest that 0.1 percent CsA is also safe and more effective than vehicle in reducing corneal and conjunctival staining and OSDI scores.The ESSENCE-2 trial confirmed the safety and efficacy of 0.1 percent CsA compared to vehicle but did not evaluate it against artificial tears, limiting its generalizability to real-world clinical practice. A direct comparison between 0.05 percent and 0.1 percent CsA as add-on therapy to artificial tears is needed to establish the superior dose for improving symptoms and clinical outcomes in moderate to severe DED. Our study aims to compare the efficacy and safety of topical 0.05 percent versus 0.1 percent cyclosporine A, both as adjuncts to artificial tears, in patients with moderate to severe dry eye disease.