Improving the post-oculoplastic tear film: trehalose as a critical adjunct

To evaluate the comparative effects of a combined trehalose-sodium hyaluronate (TD) formulation versus sodium hyaluronate (SH) monotherapy on postoperative ocular surface recovery following eyelid surgery, with additional analysis across surgical subgroups.

This retrospective comparative study included patients who underwent eyelid surgery for ectropion, entropion, or eyelid reconstruction between August 2021 and July 2024. Patients were divided into two treatment groups based on the postoperative tear substitutes used: Group SH treated with 0.15% SH eye drops, and Group TD treated with a combination of 3% trehalose and 0.15% SH. Postoperatively, patients received either 0.15% SH alone or a combination of 3% trehalose and 0.15% SH four times daily for 3mo. Ocular surface parameters-including tear break-up time (TBUT), Ocular Surface Disease Index (OSDI), Oxford staining score, meibomian gland loss (MGL), and central corneal epithelial thickness (CCET)-were assessed at baseline and 3mo. Subgroup analyses were performed by surgical indication.

A total of 114 patients were included in the study (mean age: 70.3±12.1y; 25 females). Group SH comprised 57 patients (15 females, mean age: 69.2±11.4y), while the Group TD also included 57 patients (10 females, mean age: 71.5±12.8y). Both groups showed significant improvement across all parameters; however, the TD group demonstrated superior outcomes in TBUT (mean difference: +0.77s, 95%CI: 0.12-1.42, P=0.036), Oxford score (mean difference: -0.39, 95%CI: -0.75 to -0.03, P=0.036), and MGL (mean difference: -2.02%, 95%CI: -3.78% to -0.26%, P=0.025). Subgroup analysis revealed that the TD formulation resulted in significantly better outcomes in patients undergoing reconstruction (P<0.05 for all parameters) and in most measures within ectropion and entropion subgroups. No significant differences were found in OSDI between groups, despite objective improvements favoring the TD group.

This study is the first to comparatively assess trehalose-based tear supplementation across distinct oculoplastic surgery subgroups. The combination of TD significantly enhanced postoperative ocular surface parameters-especially in complex reconstructive settings-compared to SH alone. These findings highlight the potential of tailored, antioxidative tear film strategies in optimizing recovery after eyelid surgery.