Evaluation Of Patients With Dry Eye Using Different Artificial Tears Through Lacrimal Scintigraphy

The retention times of five commonly used drops with different active ingredients (Sodium Hyaluronate (SH), Hydroxypropyl (HP) Guar+Sodium Hyaluronate, Trehalose+Sodium Hyaluronate, Dexpanthenol+Sodium Hyaluronate, Polyvinyl Alcohol (PA)+Povidone) on the ocular surface will be compared using the Lacrimal Scintigraphy method. Based on the results of this study, the goal is to identify the ideal artificial tear that remains on the ocular surface for an optimal duration.

Patients with mild dry eye disease who were followed up in our clinic between January 2023 and January 2025 were included in the study. Inclusion criteria were as follows: Schirmer score between 10-15 mm without the application of topical anesthetic drops; tear break-up time less than 10 seconds; no Fluorescein dye staining of the ocular surface; and the absence of corneal findings such as filamentary keratitis, tear debris. A complete ophthalmological examination was performed on the cases.

Lacrimal scintigraphy was performed on each case every other day, a total of three times, using the NM/CT 860 SPECT/CT device in the Nuclear Medicine Department. For the first scan, HP Guar+SH and Isotonic Saline (IS) were equally labeled with 150 microCurie Tc-99. One drop of HP Guar+SH was applied to the right eye and one drop of IS to the left eye, followed by dynamic scans for 10 minutes using the LEHR collimator of the GE NM/CT 850 device. For the second scan, the same procedure was repeated with Trehalose+SH to the right eye and Dexpanthenol+SH to the left eye. For the final scan, SH was applied to the right eye and PA+Povidone to the left eye, and the amount of the drops remaining on the ocular surface was quantitatively analyzed.

The study involved 16 patients with 32 eyes. A total of 48 scans were performed. There is a significant time-dependent decrease in eye drop measurements regardless of group (p<0.001). At the 10th minute, there was a greater decrease compared to the baseline measurement than at the 5th minute. The effect of the HP Guar+SH group on the baseline measurement was found to be significantly higher compared to the IS group (MD=0.085, p=0.031). Similarly, the effect of the HP Guar+SH on the baseline measurement was higher compared to the other groups especially Dexpanthenol+SH group (MD=0.117, p=0.155). The effect of the Trehalose+SH group on the baseline measurement was found to be significantly higher compared to the IS group (MD=0.103, p=0.003).

HP Guar+SH was found to be the ideal artificial tear that remains on the ocular surface for an optimal duration. We believe that the combination formulation of HP Guar and Hyaluronic acid has a positive effect on retention time of the artificial tear on the ocular surface.