Dry Eye Disease and Acupuncture

Dry eye disease (DED) is a multifactorial condition of the ocular surface characterized by tear film instability, hyperosmolarity, inflammation, and nociceptive change. Conventional care targets these factors through lubricants, eyelid hygiene and thermal therapy, environmental and behavioral strategies, and anti-inflammatory agents such as cyclosporine or lifitegrast; procedural interventions address meibomian gland dysfunction and tear drainage. Despite this toolbox, many patients report residual symptoms, prompting interest in complementary modalities like acupuncture. Randomized trials and meta-analyses suggest acupuncture can produce short-term improvements in validated symptom scores (e.g., OSDI), tear break-up time, and sometimes Schirmer values when compared with artificial tears or sham. However, methodological concerns limit certainty: protocols vary in point selection and frequency, masking is challenging, and sample sizes are often small with short follow-up. As such, major western guidelines do not endorse acupuncture as first-line therapy but consider it a potential adjunct within shared decision-making, especially for patients with persistent discomfort despite standard care. Proposed mechanisms span autonomic and inflammatory pathways. Acupuncture may increase parasympathetic output to the lacrimal functional unit, potentially improving aqueous secretion. It may also reduce proinflammatory cytokines on the ocular surface and influence neurosensory processing, which is relevant for patients with neuropathic-like ocular pain. Stabilization of the tear film, whether via improved glandular output or reduced blink-related instability, has been reported in some studies. These hypotheses remain under investigation; larger, well-controlled trials with standardized outcomes and longer follow-up are needed to define who benefits most and how durable the effects are. Clinically, acupuncture can be discussed as part of a multimodal regimen. Safety is generally favorable in trained hands, with minor bruising or transient soreness most common; needling near the orbit requires advanced skill. Best practice includes continuing indicated ophthalmic therapies while monitoring objective signs and patient-reported outcomes to gauge added value.

Within traditional Chinese medicine (TCM), the eye is closely linked to the Liver, which stores blood and opens to the eyes, and to the Kidney, which provides Yin and essence to nourish ocular tissues. Dryness, burning, and visual fatigue often indicate Liver–Kidney Yin deficiency with relative heat; wind-heat and Spleen or Lung dysfunction may also contribute to impaired fluid distribution. Treatment therefore aims not only at local symptom relief but at restoring systemic harmony to produce and circulate nourishing fluids to the eyes. A typical acupuncture plan combines periocular points, chosen to clear heat, brighten the eyes, and ease discomfort, with distal points that tonify Yin and blood and regulate qi. Common selections include BL1 (Jingming), ST1 (Chengqi), GB14 (Yangbai), and the extra point Taiyang locally, together with LI4 (Hegu) and LV3 (Taichong) to move qi and dispel wind-heat, and KI3 (Taixi), SP6 (Sanyinjiao), and ST36 (Zusanli) to support Kidney and Spleen and generate fluids. In deficiency patterns, gentle techniques and, in some cases, moxibustion may be used. Over a course of visits, the goals are to reduce heat and irritation, improve ocular comfort and moisture, and address systemic factors such as sleep, diet, and stress that further deplete Yin. TCM clinicians observe that improvements often build gradually over several weeks, with symptom relief preceding more stable tear film performance. For patients with post-surgical or screen-related eye strain, pattern differentiation might emphasize wind-heat and Liver qi constraint, while for autoimmune sicca (e.g., Sjögren’s) the focus leans toward nourishing Yin and gently regulating immunity in collaboration with biomedical care. Herbs may be considered separately when appropriate (for example, formulas like Qi Ju Di Huang Wan in Yin deficiency), though acupuncture alone is frequently applied when minimizing ocular surface exposure is preferred. Throughout, the TCM approach complements, rather than replaces, conventional ophthalmic treatment, with the shared aim of comfort, function, and protection of the ocular surface.