Preservative content may influence hyaluronic acid treatment outcomes in dry eye disease
Both preservative-free hyaluronic acid (PF HA) and benzalkonium chloride-preserved hyaluronic acid (BAK HA) improve the symptoms and signs of dry eye disease (DED) using identical formulations except for preservative content, according to a study.
In the randomized trial, 47 patients with DED were randomized to receive PF HA or BAK HA; 43 patients completed the study.
There was a greater reduction in Ocular Surface Disease Index (OSDI) score from baseline to month 6 in those treated with PF HA compared with BAK HA (adjusted change, -14.36 vs. -9.42; P = 0.001).
At the final visit, approximately 40% of patients treated with PF HA achieved normal OSDI scores, while no patients in BAK HA group did.
Preservative-free hyaluronic acid was associated with greater improvements over time in symptoms and select clinical signs, including OSDI (P < 0.001), non-invasive tear break-up time (P = 0.017), fluorescein corneal staining (P = 0.002), and lissamine green conjunctival staining (P < 0.001). Patients using PF HA also required fewer daily instillations (P < 0.001).
Reference
Bucsan R, Chua J, Chi L, et al. Randomized Single-Masked Study of Preservative-Free Versus Preserved Hyaluronic Acid in Dry Eye Disease. Transl Vis Sci Technol. 2026;15(11):6. doi: 10.1167/tvst.15.11.6. PMID: 42986170.
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