Randomised Research Comparing Acupuncture, Herbal Treatment and Artificial Tear Eye Drops in Dry Eye

Dry eye is a major, common medical condition with significant health burden in Singapore and worldwide. As much as one third of the adult population in Asian countries are affected by dry eye. It has been shown that dry eye affects quality of life, including the performing of daily activities such as reading and driving a car. Moderate severity of dry eye affects some patients like moderate angina. The direct and indirect cost of treating dry eye is high and increasing. For example, it costs individuals about US$800 per year to treat dry eye, but the cost to society for managing such a patient is US$12000 per year. (1-29)

Dry eye is a holistic problem affected by living habits such as working long hours on the computer and in a dry, air-conditioned environment. It is also associated with poor nutrition and intake of dietary supplements such as omega-3 and omega-6 fatty acids may help to treat dry eye. Dry eye is also a systemic immune mediated disease, and aggravated by those with autoimmune Sjögren's syndrome, rheumatoid arthritis, thyroid disease, systemic lupus erythematosis, Steven Johnson syndrome and chronic graft versus host disease.

In a recent international workshop, international experts in dry eye agree that the hallmark of this disease is raised tear osmolarity and ocular surface inflammation. Traditionally, dry eye is diagnosed by a reduced Schirmer's test and/or reduced tear break up time or the presence of dry eye symptoms. In addition to these traditional tests, it would be advantageous to incorporate measurements of osmolarity and inflammation in clinical studies. There is no definitive cure for this condition, as treatment in the form of lubricants is only symptomatic and treatment with cyclosporine eye drops is expensive and may not be well tolerated. Treatment with steroids can be effective but associated with adverse effects such as sight threatening glaucoma. In summary there is a definite medical need for alternative therapies in dry eye.

Traditional Chinese Medicine (TCM) is involved in restoring the natural balance of the body, which results in disease like dry eye when this is disturbed. In TCM philosophy, dry eye may result from syndromes such as yin deficiency in the liver or kidney. Modalities such as acupuncture or herbs can be used judiciously to restore the balance in specific patients.

Recently there have been randomized controlled studies in dry eye using acupuncture and herbs, with mixed results, refer to attachment (Table 1). The major limitation of these studies is that objective tear film evaluation such as tear osmolarity, and tear cytokines and proteins, which are indicative of ocular surface inflammation, have not been evaluated. In addition, some studies suffer from lack of proper controls or randomization.