Hyaluronic acid-based corneal epithelium-mimicking coating for therapeutic contact lenses to manage dry eye disease and prevent bacterial keratitis.

Dry eye disease (DED) is a common ocular surface disorder characterized by tear-film instability and an increased risk of bacterial keratitis (BK). Inspired by the hydrophilic glycocalyx of native corneal epithelium with intrinsic antibacterial activity, we developed a corneal epithelium-mimicking hydrogel coating for therapeutic contact lenses (CLs) to manage DED and prevent BK. The HA/DC coating was fabricated via a mild, one-pot cross-linking of hyaluronic acid (HA) and the antibacterial silane coupling agent DC5700, forming a robust, hydrophilic, and lubricious network firmly anchored on CL surfaces. The designed HA/DC hydrogel coating exhibited a significantly reduced Young's modulus (0.19 MPa) compared with the pristine CL (6.53 MPa), thus showing a high degree of corneal epithelium biomimicry with matching mechanical compliance, while delivering enhanced oxygen permeability (41.7 Barrer) and contact-active antibacterial activity. Hence, in a rabbit DED model, these biomimetic features enable the HA/DC-coated CLs to promote corneal epithelial healing, recover goblet cell density, and prolong tear film breakup time, thereby restoring tear-film stability comparable to that in healthy rabbits. The coating also inhibited biofilm formation during 14-day bacterial exposure in vitro and demonstrated prophylactic efficacy in a rat infection model. Collectively, this biomimetic strategy offers a practical and promising approach for developing therapeutic CLs to treat DED and prevent BK.