The Role of Hyaluronic Acid Eye Drops in Managing Dry Eye Syndrome: Psychological and Functional Perspectives: A systematic review

Abstract

Moamen Abdelfadil Ismail*, Ali Saleh Alzahrani, Fatemah Saleh Alsalem, Basmah Durizi K Alrawaili, Sattam Matuq Almalki, Mohammed Ali A Alghamdi, Huda Fouad Alabsi, Noor Ammar Alali and Nada Saleem S Alhawiti

Background: Dry eye syndrome (DES) is a prevalent ocular condition characterized by insufficient tear production or excessive tear evaporation, leading to discomfort, visual disturbances, and ocular surface damage. Hyaluronic acid (HA) eye drops are widely used due to their hydrating and lubricating properties, yet their efficacy compared to non-HA treatments, such as saline and artificial tears (ATs), remains debated. This study systematically reviews the effectiveness of HA eye drops in improving DES symptoms and clinical outcomes.

Methods: A systematic literature search was conducted across multiple databases for randomized controlled trials (RCTs) comparing HA-based eye drops with non-HA alternatives. Objective measures included Schemer’s test (SH test), tear breakup time (TBUT), and corneal fluorescein staining, while subjective outcomes were assessed using the Ocular Surface Disease Index (OSDI).

Results: A total of 17 RCTs were included. Pooled analysis showed that HA significantly increased tear production compared to non-HA eye drops (SMD 0.18; 95% CI 0.03, 0.33). Subgroup analysis revealed that HA was superior to saline in improving SH test (SMD 0.27; 95% CI 0.05, 0.49) and TBUT (SMD 0.28; 95% CI 0.03, 0.52).

Conclusion: HA eye drops demonstrated statistically significant improvements in tear production and tear film stability compared to saline but were not superior to ATs. While HA offers potential benefits in DES management, the clinical relevance of these findings remains uncertain. Further large-scale RCTs are required to determine the long-term efficacy of HA-based treatments.