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BMJ Open Ophthalmol. 2018 Jun 18;3(1):e000150. doi: 10.1136/bmjophth-2018-000150. eCollection 2018.

Acupuncture and herbal formulation compared with artificial tears alone: evaluation of dry eye symptoms and associated tests in randomised clinical trial.

Tong L1,2,3,4, Htoon HM1,3, Hou A1,3, Acharya RU5,6,7, Tan JH1,2,3,4,5,6,7,8,9, Wei QP8, Lim P9.

Author information

Singapore Eye Research Institute, Singapore.
Singapore National Eye Centre, Singapore.
Duke-NUS Graduate Medical School, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Ngee Ann Polytechnic, Singapore.
Department of Biomedical Engineering, SIM University, Singapore.
Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia.
Beijing University of Chinese Medicine, Beijing, China.
Singapore Chung Hwa Medical Institution, Singapore.



Dry eye is a common disease with great health burden and no satisfactory treatment. Traditional Chinese medicine, an increasingly popular form of complementary medicine, has been used to treat dry eye but studies have been inconclusive. To address this issue, we conducted a randomised investigator-masked study which included the robust assessment of disease mechanisms.

Methods and analysis:

Eligible participants (total 150) were treated with artificial tear (AT) alone, with added eight sessions of acupuncture (AC) or additional daily oral herb (HB) over a month.


Participants treated with AC were more likely to respond symptomatically than those on AT (88% vs 72%, p=0.039) with a difference of 16% (95% CI: 0.18 to 31.1). The number-to-treat with AC to achieve response in one person was 7 (3 to 157). Participants in the AC group also had reduced conjunctival redness (automatic grading with Oculus keratograph) compared with AT (p=0.043) and reduced tear T helper cell (Th1)-cytokine tumour necrosis factor α (p=0.027) and Th2-cytokine interleukin 4 concentrations (p=0.038). AC was not significantly superior to AT in other outcomes such as tear osmolarity, tear evaporation rates, corneal staining and tear break-up times. No significant adverse effects were encountered. HB was not significantly different in the primary outcome from AT (80% vs 72%, p=0.26).


AC is safe and provides additional benefit in mild to moderate dry eye up to 1 month, compared with ATs alone. Treatment is associated with demonstrable molecular evidence of reduced inflammation. Provided that suitably qualified practitioners are available to implement standardised treatment, AC may be recommended as adjunctive therapy to AT.

Trial registration number: (NCT02219204)registered on 14 August 2014.


clinical trial; cornea; ocular Surface; tears

Conflict of interest statement

Competing interests: LT is supported by an award NMRC/CSA/045/2012 and NMRC/CSA-SI/0017/2017 from National Medical Research Council, Singapore.

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