EJO ISSN 1120-6721 European Journal of Ophthalmology 2018, Vol. 28(1) 25–31 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.5301/ejo.5001011 journals.sagepub.com/home/ejo ORIGINAL RESEARCH ARTICLE opment of dry eye include ethnicity and sex, with greater inci- dence observed in Asian and Hispanic populatons (7) and in women (8). Ocular diseases such as meibomian gland dysfunc- ton (MGD), blepharits, and conjunctval diseases may induce DED. The presence of systemic conditons including arthrits, gout, osteoporosis, thyroid diseases, and ocular surgery conse- quences (9) may favor DED onset. Dry eye disease is a tear flm disorder derived from 2 dif- ferent pathogenic pathways: namely, aqueous defcient and evaporatve. The main diferences between these 2 pathways are in the diferent form of infammatory reacton at the base of the ocular surface changes. In fact, while in aqueous de- fcient dry eye adaptve responses prevail, the evaporatve form recognizes innate mechanisms as the principal pathway. It is possible to identfy the 2 forms only at the beginning of the disease, while, when the disease is fully developed, the expression of both features renders distncton between the 2 forms difcult (10, 11). Whatever the origin, DED results in hyperosmolarity of the tear flm and infammaton of the ocular surface (12). Efcacy of eyedrops containing cross-linked hyaluronic acid and coenzyme Q10 in treatng patents with mild to moderate dry eye Elisa I. Postorino 1 , Laura Rania 1 , Emanuela Aragona 1 , Carmen Mannucci 2 , Angela Alibrandi 3 , Gioacchino Calapai 2 , Domenico Puzzolo 2 , Pasquale Aragona 1 1 Department of Biomedical Sciences, Regional Referral Centre for the Ocular Surface Diseases, University of Messina, Messina - Italy 2 Department of Biomedical Sciences, University of Messina, Messina - Italy 3 Department of Economics, Unit of Statstcal and Mathematcal Sciences, University of Messina, Messina - Italy Introducton Dry eye disease (DED) is a common conditon causing sub- stantal burden on visual functon (1) and quality of life (2) and work productvity (3, 4). Epidemiologic data indicate that it is an increasing public health concern, afectng between 6% and 34% of the adult populaton, depending on the diferent diag- nostc criteria used and populaton analyzed (5, 6). Prevalence of DED increases with age and other risk factors for the devel- ABSTRACT Purpose: Dry eye disease (DED) is a common conditon causing substantal burden. A randomized, controlled, single-masked study was performed in 40 patents with mild to moderate DED to evaluate the efcacy and safety of a collyrium based on crosslinked hyaluronic acid (XLHA) with coenzyme Q10 (CoQ10). Methods: Enrolled subjects were divided into 2 groups: group A, treated with XLHA + CoQ10; and group B, treat- ed with hyaluronic acid (HA). Eyedrops were administered 4 tmes daily for 3 months. The Ocular Surface Disease Index (OSDI) questonnaire, tear break-up tme (TBUT), corneal and conjunctval staining, and meibomian gland assessment (MGD) were evaluated; furthermore, corneal aesthesiometry, in vivo corneal confocal microscopy, visual acuity, intraocular pressure (IOP), and fundus examinaton were performed. Results: At the end of treatment, OSDI score signifcantly decreased in groups A and B (p<0.01 and p<0.05, re- spectvely); the decrease was signifcantly higher in group A. Corneal staining decreased in both groups, with lower scores in group A. The MGD was signifcantly ameliorated in group A patents. No diferences were found for corneal aesthesiometry or TBUT. Epithelial cell refectvity was signifcantly reduced only in group A. For kera- tocytes and stromal matrix parameters, there was a signifcant improvement in group A. No changes were found for visual acuity, IOP, or fundus examinaton. Conclusions: The XLHA + CoQ10 treatment showed greater efectveness in DED compared to HA alone, probably due to the longer permanency on ocular surface and the antoxidant actvity of CoQ10. Therefore, XLHA + CoQ10 eyedrops could represent a new possibility in dry eye treatment. Keywords: Coenzyme Q10, Conjunctva, Cornea, Crosslinked hyaluronic acid, Dry eye, Linear hyaluronic acid Accepted: June 26, 2017 Published online: August 2, 2017 Corresponding author: Prof. Pasquale Aragona, MD, PhD Department of Biomedical Sciences Regional Referral Centre for the Ocular Surface Diseases University of Messina Messina, Italy paragona@unime.it