Why none of the eye lubricants that are sold off the counter in the USA include hyaluronic acid in their formula? Any side effect or contraindication?. In Europe and Latin America is the number one prescripciton for dry eye.
Here's a good article addressing your question:
In this 2018 article, Dr. Paul M. Karpecki, says:
Most doctors don’t realize the extent to which we have or will have access to hyaluronic acid for dry eye in the United States.
Indeed, I find lubricant eye drops with hyaluronic acid widely available in the USA. I have seen them sold in several local stores and I see them sold at online stores in the USA too.
Dr. Karpecki, says:
HA is a natural occurring glycosaminoglycan. Sodium hyaluronate is the salt form of HA, which is a more stable compound for topical application. It is commonly found in dry eyedrops because it prevents dehydration by binding to water molecules, and is highly biocompatible as it is naturally found in high concentrations in the eye. Clinical studies have shown that HA protects corneal epithelial damage via promoting corneal epithelial wound healing by stimulating epithelial migration, thus improving overall optical quality.
As far as safety, particularly for glaucoma, I do have a word of caution. In some portion (but not all) glaucoma patients, oral hyaluronic acid (or glucosamine, chondroitin sulfate) can lead to significantly elevated intraocular pressure. I do not know if topical eye drops could do the same. I have not heard any reports about it, so the risk is probably very low (maybe almost zero), but for completeness, I did want to mention the very real risk with oral glycosaminoglycan supplements. That said, oral hyaluronic acid is not a problem for all glaucoma patients, and I can report that it doesn't bother my IOP at all.
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