Efficacy of Hypotonic 0.18% Sodium Hyaluronate Eye Drops in Patients With Dry Eye Disease

Purpose: The aim of this study was to evaluate the efficacy of hypotonic 0.18% sodium hyaluronate (SH) eye drops under the clinical settings of the dry eye workshop treatment guideline for mild dry eye disease (DED). Methods: This analysis included 60 patients with DED. Patients with level 1 DED were treated with either isotonic 0.1% SH (group 1) or with hypotonic 0.18% SH eye drops (group 2). Patients with level 2 DED were treated with 0.1% fluorometholone, 0.05% cyclosporine A, and either isotonic 0.1% SH (group 3) or hypotonic 0.18% SH (group 4) eye drops. Tear film breakup time (TBUT), Schirmer test, corneal staining with fluorescein, and ocular surface disease index score were recorded at baseline, 1 month, and 3 months after treatment. Results: In group 2, TBUT at 3 months (P = 0.03) and corneal staining scores at 1 and 3 months (P <= 0.03) were significantly improved after the treatment compared with baseline scores, whereas these parameters were not changed during the follow-up period in group 1. In groups 3 and 4, TBUT and corneal staining scores at 1 and 3 months, and ocular surface disease index score and Schirmer test results at 3 months after the treatment showed significant improvements compared with the baseline score (P < 0.05). Group 4 patients showed an extended TBUT and an improved corneal staining score (P <= 0.01) at 3 months after treatment, compared with the values of group 3. Conclusions: Hypotonic 0.18% SH eye drops seemed to be effective in improving tear film stability and ocular surface integrity compared with isotonic 0.1% SH eye drops in patients with mild DED.