摘要Background:Long-term use of benzalkonium chloride (BAC)-preserved drugs is often associated with ocular surface toxicity.Ocular surface symptoms had a substantial impact on the glaucoma patients' quality of life and compliance.This study aimed to investigate the effects of sodium hyaluronate (SH) on ocular surface toxicity induced by BAC-preserved anti-glaucoma medications treatment.Methods:Fifty-eight patients (101 eyes),who received topical BAC-preserved anti-glaucoma medications treatment and met the severe dry eye criteria,were included in the analysis.All patients were maintained the original topical anti-glaucoma treatment.In the SH-treated group (56 eyes),unpreserved 0.3％ SH eye drops were administered with 3 times daily for 90 days.In the control group (55 eyes),phosphate-buffered saline were administered with 3 times daily for 90 days.Ocular Surface Disease Index (OSDI) questionnaire,break-up time (BUT) test,corneal fluorescein staining,corneal and conjunctival rose Bengal staining,Schirmer test,and conjunctiva impression cytology were performed sequentially on days 0 and 91.Results:Compared with the control group,SH-treated group showed decrease in OSDI scores (Kruskal-Wallis test:H =38.668,P ＜ 0.001),fluorescein and rose Bengal scores (Wilcoxon signed-ranks test:z =-3.843,P＜ 0.001,and z ＝-3.508,P ＜ 0.001,respectively),increase in tear film BUT (t-test:t =-10.994,P ＜ 0.001) and aqueous tear production (t-test:t =-10.328,P ＜ 0.001) on day 91.The goblet cell density was increased (t-test:t =-9.981,P ＜ 0.001),and the morphology of the conjunctival epithelium were also improved after SH treatment.Conclusions:SH significantly improved both symptoms and signs of ocular surface damage in patients with BAC-preserved anti-glaucoma medications treatment.SH could be proposed as a new attempt to reduce ocular surface toxicity,and alleviate symptoms of ocular surface damage in BAC-preserved anti-glaucoma medications treatment.