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Frontiers of Medicine

ISSN 2095-0217

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Front. Med.    2022, Vol. 16 Issue (6) : 975-983    https://doi.org/10.1007/s11684-022-0923-4
LETTER TO FRONTIERS OF MEDICINE
Acupuncture for the management of dry eye disease
Julia Prinz1, Nicola Maffulli2,3,4, Matthias Fuest1, Peter Walter1, Frank Hildebrand5, Filippo Migliorini5()
1. Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
2. Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
3. Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England
4. School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, England
5. Department of Orthopedics, University Clinic Aachen, RWTH Aachen University Clinic, 52064 Aachen, Germany
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Abstract

The effectiveness of using acupuncture for dry eye disease (DED) is controversial. Thus, this systematic review investigated the effectiveness and feasibility of using acupuncture for DED in accordance with the 2020 PRISMA statement. The outcomes of interests were (1) to evaluate the efficacy of acupuncture in improving the ocular surface disease index (OSDI), Schirmer I test score, and tear breakup time from baseline to the last follow-up; (2) to determine possible complications of using acupuncture; and (3) to investigate the superiority of acupuncture over other commonly used treatments for DED. Data from 394 patients were collected. Results showed that acupuncture significantly prolonged the tear breakup time (P < 0.0001), significantly increased the Schirmer I test score ( P < 0.0001), and significantly reduced the OSDI ( P < 0.0001) from baseline to the last follow-up. Compared with the control group, the acupuncture group had significantly greater Schirmer I test score ( P < 0.0001), significantly longer tear breakup time ( P = 0.0004), and significantly lower OSDI (P = 0.002). These results suggest that acupuncture is effective and feasible in improving symptoms and signs of DED. No severe adverse effects of acupuncture were observed.

Keywords dry eye disease      xerophthalmus      acupuncture     
Corresponding Author(s): Filippo Migliorini   
Just Accepted Date: 25 August 2022   Online First Date: 22 September 2022    Issue Date: 16 January 2023
 Cite this article:   
Julia Prinz,Nicola Maffulli,Matthias Fuest, et al. Acupuncture for the management of dry eye disease[J]. Front. Med., 2022, 16(6): 975-983.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-022-0923-4
https://academic.hep.com.cn/fmd/EN/Y2022/V16/I6/975
Fig.1  Flow chart of the literature search.
Fig.2  Methodological quality assessment.
Fig.3  Funnel plot.
Author, year Journal Follow-up (week) Patients (n) Treatment Mean age (year) Female (%) Outcome measures Acupuncture points
Dhaliwal et al., 2019 [26] Clin Ophthalmol 26.1 2425 AcupunctureSham acupuncture 54.060.0 8376 TBUT, SIT Bilateral LI-1, LI-2, at a point between LI-1 and LI-2, and bilaterally on the ears
Grönlund et al., 2004 [27] Acta Ophthalmol Scand 34.8 1010 AcupunctureArtificial tears 61.057.0 9080 TBUT, SIT Bilateral ST2, ST8, ST36, GB1, GB14, BL2, and LI4
Kim et al., 2012 [28] Plos One 8.0 7575 AcupunctureArtificial tears 48.046.1 7175 OSDI, TBUT, SIT Bilateral BL2, GB14, TE23, Ex1, ST1, GB20, LI4, LI11, and single GV23
Lee et al., 2021 [29] Integr Med Res 13 99 AcupunctureUsual care 23.724.7 6789 OSDI, TBUT, SIT Bilateral BL2, TE23, GB14, GB20, Ex1, ST1, LI4, and LI11, single GV23
Liuet al., 2017 [17] Int J Nanomedicine 8.7 1414 Acupuncture and artificial tears Artificial tears 60.760.8 100100 OSDI, TBUT BL1, BL2, SJ23, EXTRAI, ST2, LI4, GB20, DU20, ST1
Shin et al., 2010 [19] Acta Ophthalmol 4.0 2121 AcupunctureSham acupuncture 40.542.8 7671 OSDI, TBUT, SIT GV23; bilateral BL2, GB14, TE23, Ex1, ST1 and GB20; and unilateral SP3, LU9, LU10 and HT8, on the left for men and right for women
Tseng et al., 2006 [30] Am J Chin Med 8.0 179 AcupunctureArtificial tears 47.651.3 3365 TBUT, SIT Bilateral EX-HN5, GB14, SP6, ST2, TE23
Zhang et al., 2007 [20] J Tradit Chin Med 1.4 3031 AcupunctureArtificial tears NRNR 6358 TBUT GV20, BL1, BL2, EX-HN5, ST2, GB20, LI4, ST36, SP6, KI3, LR3
Tab.1  Generalities and patient baseline of the included studies
Fig.4  Most common acupuncture landmarks for dry eye disease.
Endpoint Baseline Last FU MD SE 95% CI T value P
TBUT 4.5 ± 1.8 5.9 ± 1.4 1.4 0.228 0.95 to 1.85 6.139 < 0.0001
OSDI 50.6 ± 2.1 31.2 ± 5.8 −19.3 0.617 −20.62 to −18.18 −31.450 < 0.0001
SIT 5.0 ± 0.5 6.1 ± 0.3 1.1 0.058 0.99 to 1.22 18.865 < 0.0001
Tab.2  Comparison of TBUT, OSDI, and SIT from baseline to the last follow-up
Fig.5  Results of the meta-analysis.
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