Heyedrate Clinical was recently discussed by Chief Medical Officer Dr. Cory Lappin, in Review of Optometry, a leading publication for eye care professionals, as part of a clinical conversation about artificial tears and dry eye.
The article below was originally published here on Review of Optometry .
Off the Cuff: Going Ultra: An Intriguing New Artificial Tear
Artificial tears, lubricating agents, rewetting drops. Whatever you call them, these over-the-counter drops find themselves in an interesting position in the modern dry eye landscape, with their exact place in the hierarchy of care now often a matter of debate. At the extremes, there are those who refuse to use artificial tears at all when treating dry eye regardless of their benefits, while others still solely rely on lubricating drops alone, neglecting the countless other prescription and in-office treatments available.
My take is that artificial tears definitely have a place in dry eye management, but they fill a very specific role that falls somewhere between these stances. From the patient’s perspective, their biggest concern is their symptoms—specifically discomfort. And this discomfort can ramp up at any moment. This is where artificial tears excel—providing a quick hit of relief in that moment of need. Additionally, they can be a great way to “prime” the ocular surface at the beginning of the day and before sleep, helping to keep the surface lubricated while being used in conjunction with other treatments that are more focused on addressing the underlying causes of DED.
Accordingly, I will often describe artificial tears to my patients as being a “Band-Aid in a bottle”—helpful with managing acute symptoms but not necessarily treating the underlying disease in the strictest sense. However, some newly released artificial tears are starting to blur this line between palliative and therapeutic.
A great example is the recently released Heyedrate Clinical created by EyePromise,* a new hyaluronic acid-based artificial tear. Now, you may be thinking, “So what? We have a ton of HA drops already.” And you are completely right. Hyaluronic acid has become a key ingredient in many ATs precisely because of its excellent lubricating and soothing properties. However, not all HA-based drops are created equal.
You have likely heard of HA drops being classified as either low- or high-molecular weight, with the higher weight drops being preferrable as LMW-HA may be associated with greater inflammation.1
This is where things get intriguing with Heyedrate, as it represents the first and currently only ultra-high-molecular weight HA drop available in the US.
So, what does this mean clinically? UHMW-HA may display greater residence time on the ocular surface, as the ability of HA to bind to tear film mucin increases as molecular weight increases, potentially improving ocular surface residence time. This is consistent with the finding that patients using this specific UHMW-HA formulation showed a 27% reduction in daily drop use, possibly due to its prolonged presence on the ocular surface.2
Interestingly, UHMW-HA also appears to support nerve health and function, as a 51% increase in corneal nerve length was observed when the formulation was used for eight weeks in patients with dry eye,2 and faster recovery of nerve fiber length, density, and corneal sensitivity were noted in post corneal cross-linking patients compared to those that used low molecular weight formulations.3
Whenever a novel treatment option becomes available, I am always interested to see how it performs “in the wild,” so I am excited to see if the intriguing properties of ultra-high-molecular weight hyaluronic acid demonstrated in these studies allow Heyedrate to truly cross the palliative-therapeutic divide in a way that is clinically meaningful.
*Many may not be aware but EyePromise joined with PRN, best known as the makers of the excellent Omega-3 supplement De3 Omega Benefits, to form one company that will be collectively known as EyePromise, which brings two of the most well-respected OTC companies in eye care together under one roof.
References
1. Hynnekleiv L, Magno M, Vernhardsdottir RR, et al. Hyaluronic acid in the treatment of dry eye disease. Acta Ophthalmol. 2022;100(8):844-860. doi:10.1111/aos.15159
2. van Setten GB, Baudouin C, Horwath-Winter J, et al. The HYLAN M Study: Efficacy of 0.15% High Molecular Weight Hyaluronan Fluid in the Treatment of Severe Dry Eye Disease in a Multicenter Randomized Trial. J Clin Med. 2020;9(11):3536. Published 2020 Nov 2. doi:10.3390/jcm9113536
3. Özkan G, Turhan SA, Toker E. Effect of high and low molecular weight sodium hyaluronic acid eye drops on corneal recovery after crosslinking in keratoconus patients. BMJ Open Ophthalmol. 2025;10(1):e001890. Published 2025 Mar 29. doi:10.1136/bmjophth-2024-001890
Author:
Cory J. Lappin, OD, MS, FAAO
Chief Medical Editor
