Comparison of immediate therapeutic effects of 3% diquafosol and 2% rebamipide in dry eye disease: a prospective, randomized, paired-eye trial

Both diquafosol and rebamipide improve signs and symptoms of dry eye disease (DED), but no clinical study has directly compared their immediate effects. This study compared the 30-min therapeutic and mucin-secreting effects of 3% diquafosol (DQS) and 2% rebamipide (REB). In this prospective, randomized, double-blinded study, 30 DED patients received DQS in one eye and REB in the fellow eye. Visual analog scale (VAS) score, tear break-up time (TBUT), ocular staining score (OSS), lipid layer thickness, corneal sensitivity, tear meniscus height, and tear levels of MUC5AC and MUC1 were measured before and 30 min after instillation. The mean age was 34.8 ± 13.8 years, and 23 patients were female. Both treatments significantly improved VAS score and TBUT at 30 min (all P < 0.05). VAS score improvement was greater with DQS than REB (P = 0.03), whereas TBUT changes were comparable (P = 0.141). Tear MUC5AC levels significantly increased after both treatments (both P ≤ 0.001), while MUC1 levels remained unchanged (P = 0.377/0.262). Changes in MUC5AC were similar between groups (P = 0.254). Overall, DQS and REB showed comparable early clinical benefits 30 min after instillation in DED, including symptom relief, improved tear film stability, and increased tear MUC5AC.