Management of Dry Eye Disease with Artificial Tears Containing Hyaluronic Acid and Trehalose: A Narrative Review

Melissa Barnett,1 Michelle K Rhee,2 Kendall E Donaldson3 1Baker Optometry or Alpine Blue, Davis, CA, USA; 2Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 3Bascom Palmer Eye Institute of Plantation, Plantation, FL, USACorrespondence: Melissa Barnett, Baker Optometry, 2019 Anderson Road, Suite C, Davis, CA, 95616, USA, Tel +1-530-867-3451, Email [email protected]: Dry eye disease (DED) is a growing global public health concern. The market for over-the-counter artificial tears, the mainstay treatment for DED, is also experiencing growth, driven by the rising prevalence of the condition and advancements in therapeutic formulations. The treatment landscape for DED is rapidly evolving, and currently marketed artificial tears vary in their active ingredients, use of preservatives, and formulations. Therefore, it is imperative to understand the breadth of management options and the evidence base of formulations to inform treatment decisions and treatment guidelines. In our narrative review, we provide an overview of the development and regulation of artificial tear formulations in the United States. We evaluate their active ingredients, formulations, and use of preservatives. Increasingly, preservative-free formulations are being developed that contain combinations of well-established active ingredients. In this context, a key focus of the narrative review is to critically analyze the novel, preservative-free, multidose formulation of hyaluronic acid and trehalose in artificial tears. We highlight its formulation and mechanism of action and its involvement in autophagy regulation and inflammatory response. We describe the strong and growing evidence base supporting the effectiveness and safety of this combination formulation of artificial tears in managing DED, and we also describe its use in postcataract surgery and in the real world.Keywords: artificial tears, dry eye, trehalose, hyaluronic acid, combination, safety, efficacy