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Introduction:
Diquafosol tetrasodium is an ophthalmic drug used to treat dry eye disease (keratoconjunctivitis sicca). It works as a P2Y₂ purinergic receptor agonist, promoting natural tear and mucin secretion on the eye surface. Diquafosol enhances both aqueous and mucin components of the tear film, providing a multifaceted approach to treating dry eye symptoms.

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1. Basic Information:

Drug name: Diquafosol tetrasodium

Drug class: P2Y₂ purinergic receptor agonist

Route of administration: Topical (eye drops)

Therapeutic use: Treatment of dry eye disease

Common brand name: Diquas™ (especially in Japan and South Korea)

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2. Mechanism of Action:

Diquafosol activates P2Y₂ receptors located on the ocular surface, including conjunctival epithelial cells and goblet cells. Activation of these G protein-coupled receptors stimulates:

Chloride ion and water secretion from epithelial cells, promoting hydration of the ocular surface.

Secretion of mucins (especially MUC5AC) from goblet cells, enhancing mucin layer spread and stabilization of the tear film.

Barrier protection and improved ocular surface health by promoting a more uniform and stable tear film.

Unlike artificial tears, which act by providing temporary relief through external moisturization, diquafosol stimulates the natural production of tear components.

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3. Indications and Uses:

Primary treatment for dry eye disease, especially aqueous-deficient and mucin-deficient types.

Beneficial in treatment-resistant dry eyes, such as in Sjögren’s syndrome or post-LASIK dry eye.

Research also supports potential benefits in contact lens-related dry eye and meibomian gland dysfunction (as adjunct).

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4. Formulation and Dosage:

Usually formulated as 3% diquafosol tetrasodium ophthalmic solution.

Dosage: Typically 1 drop in each eye, six times per day.

Available in single-use sterile vials or multidose preservative-free bottles in some markets.

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5. Safety and Side Effects:

Diquafosol is generally well tolerated. Most side effects are mild and transient:

Eye irritation or discomfort

Mild conjunctival hyperemia (eye redness)

Blurred vision (temporary)

Rare cases of allergic reaction

Unlike some immunosuppressive eye drops, diquafosol does not act on inflammatory pathways directly, which may result in fewer systemic or long-term effects.

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6. Comparison to Other Dry Eye Therapies:

Artificial tears: Provide short-term lubrication without stimulating natural secretion.

Cyclosporine or lifitegrast: Target immune/inflammatory aspects of dry eye, often take weeks to work.

Diquafosol: Acts through purinergic stimulation, offering a faster onset by promoting endogenous tear and mucin release.

It may be used alone or in combination with other therapies for more comprehensive dry eye management.

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7. Pharmacology and Pharmacokinetics:

Acts locally on the ocular surface — minimal systemic absorption.

Eliminated mainly through tear drainage; systemic exposure is considered negligible.

Onset of action is relatively fast, with symptomatic improvement often within several days.

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8. Development and Regulatory Status:

Developed originally by Inspire Pharmaceuticals and Santen Pharmaceutical (Asia).

Approved in Japan in 2010 and South Korea in 2011.

Not yet FDA-approved in the United States (though used in clinical trials and as investigational therapy).

Clinical studies suggest strong efficacy for improvement in tear film stability, ocular surface staining scores, and patient-reported outcomes.

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9. Research and Future Applications:

Ongoing clinical research explores its use in:

Combination with sodium hyaluronate for enhanced symptomatic relief

Contact lens-associated dry eye discomfort

Dry eye in patients with meibomian gland dysfunction or post-ocular surgery

Additional purinergic receptor agonists are also under development for broader therapeutic applications.

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10. Conclusion:

Diquafosol tetrasodium is a novel and effective treatment for dry eye disease that works by stimulating natural tear and mucin secretion via P2Y₂ receptor activation. Its unique mechanism makes it a valuable alternative or adjunct to traditional dry eye therapies, especially in cases where artificial tears or anti-inflammatory agents are insufficient. With favorable tolerability and local action, diquafosol offers promising benefits for millions affected by dry eye syndrome.

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