Trial: Electroacupuncture Efficacy in Dry Eye Stronger Than Artificial Tears

Compared with artificial tears, electroacupuncture may offer superior efficacy in improving tear film stability and symptoms of dry eye, a pilot trial published in Acta Ophthalmologica suggests.

“[Electroacupuncture] is a kind of modern acupuncture combining manual acupuncture with pulsating electrical stimulation, believed to produce a more intensive stimulation with better repeatability than manual acupuncture,” researchers explain.

The researchers conducted a randomized controlled pilot trial to evaluate the clinical efficacy of electroacupuncture compared with that of artificial tears in treatment of dry eye. 

The study’s primary outcomes were noninvasive tear film breakup time and tear meniscus height. Secondary outcomes included the ocular surface disease index (OSDI) score, Schirmer I test, corneal sodium fluorescein staining score, corneal topography descriptors surface asymmetry index and surface regularity index, corneal sensitivity, 36-item Short-form Health Survey (SF-36) score, and Hospital Anxiety and Depression Scale score. The investigators assessed all outcomes at baseline, after treatment (week 4) and during follow up (week 8).

The intention-to-treat population included 77 patients with dry eye who were randomly assigned (1:1) to receive electroacupuncture 3 times per week (n=39; 66.7% women and 33.3% men; median age, 34.0 years) or 0.1% sodium hyaluronate artificial tears 4 times per day (n=38; 68.4% women and 31.6% men; median age, 26.5 years), for 4 weeks. Baseline characteristics were well balanced between the groups (all P >.05).

The researchers observed significantly more improvement with electroacupuncture than with artificial tears in mean change from baseline for noninvasive tear film breakup time (week 4, 1.55±0.26 vs 0.39±0.26 seconds; P =.003; week 8, 1.40±0.31 vs 0.15±0.32 seconds; P =.008), tear meniscus height (week 4, 0.06±0.01 mm vs 0.03±0.01 mm; P =.014; week 8, 0.06±0.01 mm vs 0.02±0.01 mm; P =.009), OSDI score (week 4, -18.96±2.27 vs -11.60±2.30; P =.029; week 8, -19.02±2.88 vs -9.21±2.92; P =.022), corneal sodium fluorescein staining score (week 8, -1.87±0.40 vs -0.42±0.37; P =.036), SF-36 role-physical score (week 4, 12.51±2.98 vs 0.97±3.02; P =.010). 

They observed no significant differences between the groups in mean change from baseline for the Schirmer I test, surface asymmetry index, surface regularity index, corneal sensitivity, other SF-36 subscale scores, and Hospital Anxiety and Depression Scale scores (all P >.05). 

The team found that treatment with electroacupuncture was well-tolerated, with minimal adverse events and no severe adverse event in either group. Only 3 electroacupuncture-related adverse events occurred (all ecchymosis in the treated acupoints). 

“[Electroacupuncture] had durable effects in prolonging [non-invasive tear film breakup time] and increasing [tear meniscus height], alleviating subjective symptoms and ameliorating ocular surface damage in DE patients, more effective than 0.1% sodium hyaluronate artificial tears,” report the researchers.

Limitations of the study included the relatively small sample size, short follow-up duration,  potential inadequacy of a short course of electroacupuncture treatment (4 weeks) for patients with severe dry eye, and lack of sham electroacupuncture as a control group.