Effects of HP-Guar Nano-emulsion Artificial Tears on Symptoms and Severity of Meibomian Gland Dysfunction in Evaporative Dry Eye During a 90-Day Longitudinal Study

BACKGROUND: To evaluate whether hydroxypropyl-guar (HP-Guar) nano-emulsion artificial tears improve symptoms, quality of life, severity of meibomian gland dysfunction (MGD) and evaporative dry eye (EDE)-related parameters in mild-to-moderate EDE participants over 90 days. METHODS: Fifty-one mild-to-moderate EDE participants were recruited for a single-masked, longitudinal clinical trial without a control group or placebo. Inclusion criteria comprised: Ocular Surface Disease Index (OSDI) between 13-32 points; at least one positive diagnostic sign (Non-Invasive Tear Break-Up Time [NIBUT] <10 s and/or corneal staining >1) and two classification signs (Tear Meniscus Height [TMH] ≥0.20 and ≤0.50 mm and MGD score ≥5 points). Participants applied 1-2 drops of HP-Guar nano-emulsion artificial tears per eye, four times daily for 90 days, with follow-up assessments at baseline, 30, 60 and 90 days. Three groups of tests were conducted each session: DED symptomatology and quality of life (OSDI, EuroQol 5-Dimension 5-Level [EQ-5D-5L]), MGD severity (MGD score, meibomian gland loss area [MGLA]) and EDE-related parameters (meibomian gland expression [MGE], Meibometry, lipid layer pattern (LLP), NIBUT, ocular redness and corneal staining). RESULTS: Significant differences in OSDI score, EQ-5D-5L in the 'Healthy today' scale, MGD score, lower eyelid MGLA and LLP were observed across sessions (all p ≤ 0.03). However, no significant differences were found in EQ-5D-5L score, upper eyelid MGLA, MGE, Meibometry, NIBUT-first, NIBUT-average, limbal or bulbar redness in any area or corneal staining (all p ≥ 0.09). CONCLUSIONS: This 90‑day single‑masked study without a control group found that HP‑Guar nano‑emulsion eye drops were associated with improvements in symptoms, perceived health and MGD‑related signs. These findings are exploratory and require confirmation in controlled trials.