A modern view on the transformation of hyaluronic acid-based tear substitutes as a response to the challenges of the evolution of dry eye syndrome in Ukraine | Ukrainian Medical Journal

Sobolta N.S.

Main
Publications
A modern view on the transformation of hyaluronic acid-based tear substitutes as a response to the challenges of the evolution of dry eye syndrome in Ukraine

A modern view on the transformation of hyaluronic acid-based tear substitutes as a response to the challenges of the evolution of dry eye syndrome in Ukraine

June 24, 2026

Ophthalmology

Sobolta N.S.

УДК: 617.7-008.811.4

DOI: 10.32471/umj.1680-3051.278208

Keywords :

Specialities :

Resume

Dry eye syndrome has undergone a significant transformation: from a disease of predominantly older age to an epidemic that affects young socially active patients due to digital stress and lifestyle changes. The modern understanding of the disease includes tear film instability, hyperosmolarity, inflammation and neurosensory changes, which puts forward new requirements for tear substitutes: film stabilization, friction reduction, epithelial protection and repair support. Cross-linked hyaluronic acid meets these requirements due to its 3D structure, thixotropy, resistance to degradation and regenerative potential.

References

1. Wolffsohn J.S., Benítez-Del-Castillo J.M., Loya-Garcia D. et al. (2025) TFOS DEWS III: Diagnostic Methodology. Am J Ophthalmol., 279: 387–450. doi: 10.1016/j.ajo.2025.05.033.
2. Stapleton F., Garrett Q., Chan C. et al. (2024) Epidemiology and risk factors of dry eye disease. Contact Lens Anterior Eye. doi.org/10.1016/j.clae.2023.102098.
3. Yu J., Asche C.V., Fairchild C.J. (2011) The economic burden of dry eye disease in the United States: a decision tree analysis. Cornea. doi.org/10.1097/ICO.0b013e3181f7f363.
4. Boccardo L., Gharbiya M., Cavallotti C. et al. (2024) Lifestyle and environmental risk factors for dry eye disease. Int. J. Environ. Res. Public Health. doi.org/10.3390/ijerph21091197.
5. Azari A.A., Moin M., Safapour S. (2024) Dry eye disease. StatPearls. http://www.ncbi.nlm.nih.gov/books/NBK470411.
6. Huang Y., Leung A.K., Wolffsohn J.S. et al. (2021) Digital screen use and dry eye: a systematic review and meta-analysis. Contact Lens Anterior. Eye. doi.org/10.1016/j.clae.2021.01.004.
7. Narayanan S., Miller W.L., Prager T.C. et al. (2010) Blink rate and incomplete blinking during visual display terminal use. Invest. Ophthalmol. Vis .Sci. doi.org/10.1167/iovs.09-3901.
8. Himebaugh N.L., Begley C.G., Bradley A., Wilkinson J.A. (2009) Blinking and tear break-up during four visual tasks. Optom. Vis. Sci. doi.org/10.1097/OPX.0b013e3181ca7c5b.
9. Baudouin C., Rolando M., Benitez Del Castillo J.M. et al. (2019) Reconsidering the central role of mucins in dry eye and ocular surface diseases. Prog. Retin. Eye Res. doi.org/10.1016/j.preteyeres.2018.11.007.
10. Fallacara A., Baldini E., Manfredini S., Vertuani S. (2018) Hyaluronic acid in the third millennium. Polymers. doi.org/10.3390/polym10070701.
11. Cañadas P., Borau A., Broc L. et al. (2016) Expression of CD44 standard and variant isoforms in the human conjunctival epithelium. Eur. J. Ophthalmol. doi.org/10.5301/ejo.5000876.
12. Huang X., Brazel C.S. (2021) Hyaluronic acid-based drug delivery systems. J. Control. Release. pmc.ncbi.nlm.nih.gov/articles/PMC8123179.
13. Sánchez-González J.M., De-Hita-Cantalejo C., González-Rodríguez M.L. et al. (2024) Efficacy assessment of liposome crosslinked hyaluronic acid and standard hyaluronic acid eye drops for dry eye disease management. Front. Med. doi.org/10.3389/fmed.2024.1264695.
14. Yu F., Zheng M., Zhang A.Y. et al. (2021) A chemically crosslinked hyaluronic acid hydrogel as a long-lasting ocular surface lubricant. Bioeng. Transl. Med. doi.org/10.1002/btm2.10227.
15. Fallacara A., Vertuani S., Panozzo G. et al. (2017) Novel artificial tears containing cross-linked hyaluronic acid: an in vitro re-epithelialization study. Molecules. doi.org/10.3390/molecules22122104.
16. Fraser J.R.E., Laurent T.C., Laurent U.B.G. (1997) Hyaluronan: its nature, distribution, functions and turnover. J. Intern. Med., 242: 27–33. doi.org/10.1046/j.1365-2796.1997.00170.x.
17. Berkó S., Maroda M., Bodnár M. et al. (2013) Advantages of cross-linked versus linear hyaluronic acid for semisolid skin delivery systems. Eur. Polym. J. doi.org/10.1016/j.eurpolymj.2013.04.001.
18. Mikhail A.S., Eetezadi S., Allen C. (2019) Physicochemical properties of hyaluronic acid-based lubricant eye drops. Transl. Vis. Sci. Technol. tvst.arvojournals.org/article.aspx?articleid=2754757.
19. Lai J.Y. (2012) Solvent composition is critical for carbodiimide cross-linking of hyaluronic acid as an ophthalmic biomaterial. Materials. doi.org/10.3390/ma5101986.
20. Sánchez-González J.M., González-Rodríguez M.L., Mirón-Mombiela R. et al. (2025) Decreased inflammatory biomarkers after using artificial tears with Aloe vera and hypromellose for dry eye. Clin. Exp. Optometry. doi.org/10.1080/08164622.2025.2485236.
21. Cagini C., Torroni G., Fiore T. et al. (2017) Tear film stability in Sjögren syndrome patients treated with hyaluronic acid versus crosslinked hyaluronic acid-based eye drops. J. Ocul. Pharmacol. Ther. doi.org/10.1089/jop.2016.0149.
22. Roszkowska A.M., Inferrera L., Spinella R. et al. (2022) Clinical efficacy, tolerability and safety of a new multiple-action eyedrop in subjects with moderate to severe dry eye. J. Clin. Med. doi.org/10.3390/jcm11236975.
23. Wolffsohn J.S., Arita R., Chalmers R. et al. (2017) TFOS DEWS II Diagnostic Methodology report. Ocul. Surf. pmc.ncbi.nlm.nih.gov/articles/PMC9840372.
24. Jones L., Craig J.P., Markoulli M. et al. (2025) TFOS DEWS III: Management and Therapy. Am. J. Ophthalmol. doi.org/10.1016/j.ajo.2025.05.039.