Efficacy and tolerability of esculin and digitalis glycosides eye drops versus sodium hyaluronate in pediatric digital screen-related visual fatigue and dry eye

Background: Visual fatigue and dry eye are prevalent pediatric ophthalmic conditions. Esculin-digitalis glycosides and sodium hyaluronate eye drops are widely used, yet their specific clinical value remains unclear. Objectives: This study compared esculin and digitalis glycosides eye drops with sodium hyaluronate eye drops for pediatric digital screen-related visual fatigue and dry eye, assessing efficacy and tolerability. Methods: In the observational retrospective study, 126 patients were initially screened from December 2022 to December 2024 and 122 were enrolled after exclusions. They were divided into two groups according to the treatment plan: the sodium hyaluronate group (n=60) and the esculin-digitalis glycosides group (n=62). After propensity score matching (PSM), 50 patients were included in each group. The primary outcome measures included the Ocular Surface Disease Index (OSDI) score, Tear Film Breakup Time (TBUT), tear secretion volume and Corneal Fluorescein Staining (CFS) score. The secondary outcome measures included Functional Visual Acuity (FVA) accuracy rate, Tear Meniscus Height (TMH), Meibomian Gland Function Score (MGFS), incidence of adverse events and the Scale of Quality of Life for Diseases with Visual Impairment score (SQOL-DVI). Results: After PSM, baseline data showed no significant between-group differences (all P > 0.05). Following 3 months of treatment, the esculin-digitalisglycosides group had greater reductions in OSDI, CFS and MGFS scores (all P < 0.001), longer TBUT, higher tear secretion, improved FVA accuracy and increased TMH than the sodium hyaluronate group (all P < 0.001). The esculin-digitalisglycosides group also had a higher SQOL-DVI total score. Adverse event rates were 4% (esculin-digitalisglycosides) and 8% (sodium hyaluronate), with no significant difference (P = 0.400) and no serious adverse events reported. Conclusion: Esculin and digitalis glycosides eye drops show superior efficacy to sodium hyaluronate eye drops in treating pediatric digital screen-related visual fatigue and dry eye, with good tolerability and clinical value.