Hyaluronic acid in the treatment of dry eye disease

Dry eye disease (DED) is a highly prevalent and debilitating condition affecting several hundred million people worldwide. Hyaluronic acid (HA) is a naturally occurring glycosaminoglycan commonly used in the treatment of DED. This review aims to critically evaluate the literature on the safety and efficacy of artificial tears containing HA used in DED treatment. Literature searches were conducted in PubMed, including MEDLINE, and in Embase via Ovid with the search term: (hyaluronic acid OR hyaluronan OR hyaluronate) AND (dry eye OR sicca). A total of 53 clinical trials are included in this review, including eight placebo-controlled trials. Hyaluronic acid concentrations ranged from 0.1% to 0.4%. Studies lasted up to 3 months. A broad spectrum of DED types and severities was represented in the reviewed literature. No major complications or adverse events were reported. Artificial tears containing 0.1% to 0.4% HA were effective at improving both signs and symptoms of DED. Two major gaps in the literature have been identified: 1. no study investigated the ideal drop frequency for HA-containing eyedrops, and 2. insufficient evidence was presented to recommend any specific HA formulation over another. Future investigations assessing the optimal drop frequency for different concentrations and molecular weights of HA, different drop formulations, including tonicity, and accounting for DED severity and aetiology are essential for an evidence-based, individualized approach to DED treatment.

Automated summary

This review evaluates the safety and efficacy of artificial tears containing hyaluronic acid (HA) in the treatment of dry eye disease (DED). The results show that artificial tears with 0.1% to 0.4% HA are effective in improving both signs and symptoms of DED, with no major complications or adverse events reported. However, two major gaps in the literature have been identified: the ideal drop frequency for HA-containing eyedrops has not been studied, and there is insufficient evidence to recommend any specific HA formulation over another. Future research should focus on exploring the optimal drop frequency for different concentrations and molecular weights of HA, as well as different drop formulations, taking into account DED severity and etiology.