Clinical Observation of Recombinant Bovine Basic Fibroblast Growth Factor Eye Gel Combined with Tobramycin Dexamethasone Eye Drops in the Treatment of Dry Eye Syndrome in Patients after Cataract Surgery

Objective:To evaluate the therapeutic effect of recombinant bovine basic fibroblast growth factor(rbFGF)eye gel combined with tobramycin-dexamethasone(TOB-Dex)eye drops on dry eye syndrome(DES)after cataract surgery.Methods:86 patients with DES after cataract surgery,admitted from November 2021 to November 2023,were randomly divided into groups.The observation group included 43 patients treated with rbFGF eye gel combined with TOB-Dex eye drops.The reference group included 43 patients treated with TOB-Dex eye drops alone.Multiple indicators,including total effective rate and clinical symptom scores,were compared between the two groups.Results:The total effective rate in the observation group was higher than in the reference group(P<0.05).Before treatment,there were no differences in clinical symptom scores,serum factors,or disease severity scores between the two groups(P>0.05).Three weeks after treatment,the observation group had lower clinical symptom scores,serum factors,and disease severity scores compared to the reference group(P<0.05).The adverse reaction rate in the observation group was lower than in the reference group(P<0.05).Conclusion:rbFGF eye gel combined with TOB-Dex eye drops can improve the clinical efficacy for patients with DES after cataract surgery,alleviate disease symptoms,reduce inflammatory responses,and have fewer adverse reactions.

Randomized controlled trial on the efficacy and safety of autologous serum eye drops in dry eye syndrome

BACKGROUND Autologous serum eye drops(ASEDs),a novel treatment derived from blood serum,have emerged as a groundbreaking solution for managing dry eye syndrome(DES).These drops have shown significant promise in relieving the distressing symptoms of DES.This study aimed to evaluate the safety and effectiveness of ASEDs compared to traditional treatments,which often prove inadequate or result in unwanted side effects,particularly in individuals with moderate-to-severe DES.AIM To evaluate whether ASEDs are safer and more effective than conventional artificial tears in the treatment of moderate-to-severe DES.METHODS This multi-centered randomized controlled trial included 240 patients with moderate-to-severe DES from three ophthalmology clinics in China.They were randomly assigned to receive either ASEDs or artificial tears for 12 wk.The primary outcome was the change in the ocular surface disease index(OSDI)score,with secondary outcomes including tear break-up time(TBUT),Schirmer I test,corneal fluorescein staining(CFS),and conjunctival impression cytology(CIC).Statistics analysis was performed using an analysis of covariance with adjustments made for baseline values.RESULTS Our findings revealed that both ASEDs and artificial tears significantly improved the OSDI score,TBUT,Schirmer I test,CFS,and CIC from baseline to week 12.The ASEDs group showed significantly greater improvement in all these measures than the artificial tears group(all P values<0.05).The average difference in the OSDI score between the two cohorts was-10.3(95%confidence interval:-13.6 to-7.0),indicating a substantial improvement in the ASEDs group.The occurrence of adverse events was comparable between cohorts,with no reports of severe adverse events.CONCLUSION ASEDs are more effective and safer than artificial tears for mitigating symptoms of moderate-to-severe DES.ASEDs could be an alternative/supplementary therapy for patients with DES less responsive to traditional treatments.

Analyze interleukin-1β,interleukin-6,and tumor necrosis factor-αlevels in dry eye and the therapeutic effect of cyclosporine A

BACKGROUND Dry eye is a common eye disease.Artificial tears supplements are widely used for the treatment of dry eyes.However,multiple adverse effects have been observed in patients receiving long-term treatment with artificial tears,which may affect the therapeutic effect.AIM To analyze the characteristics of interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-alpha(TNF-α)levels in patients with dry eye and the therapeutic effect of artificial tears combined with cyclosporine A.METHODS A total of 124 dry eye patients treated at The First People’s Hospital of Xining from April 2020 to April 2022 were selected as the observation group,while 20 healthy individuals served as the control group during the same period.Levels of inflammatory markers,including IL-1β,IL-6,and TNF-α,were analyzed.The observation group was further divided into a study group and a control group,each consisting of 62 patients.The control group received artificial tears,whereas the study group received a combination of artificial tears and cyclosporine A.Inflammatory markers,Schirmer’s test(SIT),tear break-up time(TBUT),corneal fluorescein staining(CFS),National Eye Institute Visual Function Questionnaire-25(NEI-VFQ-25)scores,and adverse events(AEs)were compared between the two groups.RESULTS The observation group exhibited significantly elevated serum levels of IL-1β,IL-6,and TNF-αin comparison to the healthy group.Following treatment,the study group demonstrated substantial reductions in IL-1β,IL-6,and TNF-αlevels relative to the control group.Moreover,after treatment,the study group experienced a marked decrease in CFS scores and significant increases in both SIT and BUT levels when compared to the control group.Additionally,significant improvements were observed in the primary symptom of dry eye and secondary symptoms such as photophobia,foreign body sensation,fatigue,red eye,and burning sensation within the study group.Furthermore,post-treatment NEI-VFQ-25 scores across all dimensions exhibited significant enhancements in the study group compared to the control group(P<0.05).It is noteworthy that significant AEs were reported in both groups throughout the treatment period.CONCLUSION Cyclosporine A combined with artificial tears is effective in treating dry eye,yielding enhanced outcomes by improving SIT and TBUT levels,reducing CFS scores,and ameliorating vision-related quality of life.

Efficacy of recombinant human epidermal growth factor plus sodium hyaluronate eye drops in diabetic dry eye post-cataract surgery

BACKGROUND Dry eye syndrome(DES)after diabetic cataract surgery can seriously affect the patient’s quality of life.Therefore,effective alleviation of symptoms in patients with this disease has important clinical significance.AIM To explore the clinical effect of recombinant human epidermal growth factor(rhEGF)plus sodium hyaluronate(SH)eye drops on DES after cataract surgery in patients with diabetes.METHODS We retrospectively evaluated 82 patients with diabetes who experienced DES after cataract surgery at Tianjin Beichen Hospital,Affiliated Hospital of Nankai University between April 2021 and April 2023.They were classified into an observation group(42 cases,rhEGF+SH eye drops)and a control group(40 cases,SH eye drops alone),depending on the different treatment schemes.The therapeutic efficacy,dry eye symptom score,tear film breakup time(TFBUT),basic tear secretion score[assessed using Schirmer I test(SIt)],corneal fluorescein staining(FL)score,tear inflammatory markers,adverse reactions during treat-ment,and treatment satisfaction were compared between the two groups.RESULTS Therapeutic efficacy was higher in the observation group compared with the control group.Both groups showed improved TFBUT and dry eye,as well as improved SIt and FL scores after treatment,with a more pronounced improvement in the observation group.Although no marked differences in adverse reactions were observed between the two groups,treatment satisfaction was higher in the observation group.CONCLUSION rhEGF+SH eye drops rendered clinical benefits to patients by effectively ameliorating dry eye and visual impairment with favorable efficacy,fewer adverse reactions,and high safety levels.Thus,this treatment should be promoted in clinical practice.

A randomized controlled trial of omega-3 fatty acids in dry eye syndrome

AIM:To evaluate the role of dietary supplementation of omega-3 fatty acids in dry eye syndrome.METHODS:A prospective,interventional,placebo controlled,double blind randomized trial was done at two referral eye centers.Two hundred and sixty-four eyes of patients with dry eye were randomized to receive one capsule(500mg)two times a day containing 325mg EPA and 175mg DHA for 3 months(omega-3 group).The omega-3 group was compared to a group of patients(n=254)who received a placebo(placebo group).There were 4 patient visits(at baseline,1 month,2 months and3 months).On each visit,recording of corrected distance visual acuity(CDVA),slit lamp examination and questionnaire based symptom evaluation and scoring was done.A symptomatic score of 0-6 was mild,6.1-12moderate and 12.1-18 severe dry eye.Response to intervention was monitored by routine tear function tests like Schirmer I test,tear film break-up time(TBUT),Rose Bengal staining and most notably,conjunctival impression cytology.RESULTS:Sixty-five percent of patients in the omega-3group and 33%of patients in placebo group had significant improvement in symptoms at 3 months(P=0.005).There was a significant change in both Schirmer’s test value and TBUT values in the omega-3group(P【0.001),both comparisons.However,there was a larger drift in TBUT values in omega-3 than the placebo group,in comparison to Schirmer’s test values.The mean TBUT score was 2.54±2.34 in the omega-3group and 0.13±0.16 in placebo group,respectively.The mean reduction in symptom score in omega-3 group was 2.02±0.96 as compared to 0.48±0.22 in placebogroup(P【0.001).Despite a slight increase mean score,the Schirmer scores did not correlate well with symptomatic improvement.CONCLUSION:Omega-3 fatty acids have a definite role for dry eye syndrome.The benefit seems to be more marked in conditions such as blepharitis and meibomian gland disease.The role of omega fatty acids in tear production and secretion needs further evaluation.

Alcohol consumption and dry eye syndrome: a Metaanalysis

AIM：To quantify the association between alcohol consumption and dry eye syndrome（DES） with Meta-analysis of published case-control and cross-sectional studies. METHODS： Three databases were screened for potentially eligible studies through Nov.30,2015,Pub Med,Web of Science,and the Cochrane Library.Odds ratios（ORs） were pooled with 95% confidence intervals（CIs） to evaluate the relationship between alcohol consumption and DES risk.Subgroup analyses were performed according to diagnostic criteria,publication year,sample size,alcohol intake and adjusted factors.RESULTS： A total of 10（9 case-control and 1 crosssectional） studies from 8 articles were included in this Meta-analysis.The pooled results showed that alcohol consumption would significantly increase the risk of DES（OR 1.15,95% CI： 1.02-1.30）,and the results were independent of smoking,hypertension,diabetes and thyroid disease history.And the results of subgroup analyses indicated an increased incidence of DES diagnosed by typical DES symptoms and positive objective tests together（OR 1.18,95% CI： 1.01-1.39）among drinkers,but not by typical DES symptoms alone（OR 1.11,95% CI： 0.94-1.32）.What＇s more,any drinkers were at higher risk of suffering from DES（OR 1.33,95%CI： 1.31-1.34）,while heavy drinkers not（OR 1.01,95% CI：0.86-1.18）.CONCLUSION： The present Meta-analysis suggests that alcohol consumption may be a significant risk factor for DES.Alcohol-induced peripheral neuropathymay falsely reduce the prevalence of DES among heavy drinkers.Future prospective studies of alcohol consumption and DES risk are needed to confirm our results.

Metabolic syndrome risk factors and dry eye syndrome:a Meta-analysis

AIM：To explore the relationship between metabolic risk factors and dry eye syndrome（DES）.METHODS：Retrieved studies on the association of metabolic syndrome risk factors（hypertension,hyperglycemia,obesity,and hyperlipidemia） and DES were collected from PubMed,Web of Science,and the Cochrane Library in December 2015.Odds ratio（OR） with 95% confidence interval（Cl） were pooled to evaluate the final relationship.Subgroup analyses were conducted according to diagnostic criteria of DES.RESULTS：Nine cross-sectional studies and three case-control studies were included in this Meta-analysis.The pooled results showed that people with hypertension,hyperglycemia,and hyperlipidemia had a higher risk of suffering from DES（P〈0.05）,especially the typical DES symptoms.On the other hand,obesity did not increase the risk of DES.CONCLUSION：The present Meta-analysis suggests that all metabolic risk factors except obesity were risk factors for DES.

Preventive effect of Angelica gigas Nakai extract oral administration on dry eye syndrome

Objective:To identify the preventive effect of Angelica gigas Nakai(A.gigas Nakai)extract in a benzalkonium chloride-induced dry eye model.Methods:A total of 28 mice were divided into 4 groups:1)Normal group:mice received only saline;2)positive control group:mice received an oral solution without A.gigas Nakai extract at 10:00 a.m.and 0.2%benzalkonium chloride eye drops at 2:00 p.m.;3)A.gigas Nakai extract(5 mg);4)A.gigas Nakai extract(10 mg).Both group 3)and group 4)received an oral solution with A.gigas Nakai extract(either 5 mg/kg or 10 mg/kg)at 10:00 a.m.and 0.2%benzalkonium chloride eye drops at2:00 p.m.After 14 d of follow-up,tear volume measurement and fluorescein staining were evaluated for the recovery effects on ocular surface.Histologic analysis was conducted by hematoxylin and eosin staining.Apoptosis on ocular epithelium layer was examined using terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining.Expression of TNF-a was also measured using western blot analysis.Results:An increase in both the tear volume and the sustained fluorescein staining scores was observed,demonstrating the preventive effects of A.gigas Nakai extract.Structure changes such as irregularity of the epithelial layer and corneal epithelial cell death were inhibited in the A.gigas Nakai extract groups.Expression of TNF-αmoderately declined;however,its expression level was still higher,compared to the normal group.Conclusions:Results from the current study show the significant preventive effect of A.gigas Nakai extract in a mouse model of benzalkonium chloride-induced dry eye syndrome.Thus,A.gigas Nakai extract could be considered as an oral preventive agent for dry eye syndrome in the future.

A combined treatment for patients with dry eye and associated laryngopharyngeal reflux:a real-life approach

AIM:To evaluate the efficacy and tolerability of administering a combined therapy in patients with dry eye syndrome(DES)and associated laryngopharyngeal reflux(LPR).METHODS:The study was retrospective,open,observational,and conducted in a real-life setting.Patients had pathological symptom assessment in dry eye(SANDE)and reflux symptom index(RSI)at baseline.Patients were re-assessed after 1mo and at the end of treatment.The treatment consisted of a three-month course based on the combined therapy:Gastroftal eye drops,one drop three times a day,and Gastroftal tablets,two tablets after lunch and two tablets after dinner.Tear break-up-time(TBUT)test,Schirmer test,RSI,and SANDE questionnaire were evaluated.RESULTS:The study included 253 patients.The mean age was 58±11.19y.TBUT test score and Schirmer’s test significantly increased(both P<0.001)after 1mo and at the end of treatment.The RSI score and SANDE scores significantly decreased(both P<0.001)after 1mo and at the end of treatment.CONCLUSION:The current,retrospective,and open study shows that combined therapy using Gastroftal eye drops and tablets could represent a valuable option in managing patients with DES associated with LPR.

Corneal sensitivity,ocular surface health and tear film stability after punctal plug therapy of aqueous deficient dry eye

AIM： To evaluate the effect of punctal occlusion using thermosensitive（smart plug） versus silicone plug for management of aqueous deficient dry eye on cornea sensitivity, ocular surface health and tear film stability.METHODS： A comparative prospective interventiona case study included 45 patients with bilateral severe form of aqueous deficient dry eye. In each patient, the smar plug was inserted in the lower punctum of the right eye which was considered as study group 1 and silicone plug was inserted in the lower punctum of the left eye o the same patient which was considered as study group2. All patients were subjected to careful history taking and questionnaire for subjective assessment of severity of symptoms. Corneal sensitivity, corneal fluorescein rose bengal staining, Schirmer＇s I test, tear film break up time and conjunctival impression cytology were performed pre and 1, 3 and 6mo post plug insertion.RESULTS： A statistically significant improvement in subjective and objective manifestations occurred following treatment with both types of plugs（P 〈0.01）The thermosensitive plug caused significant overal improvement, decrease in frequency of application o tear substitutes and improvement of conjunctiva impression cytology parameters in the inserted side（P 〈0.01）. Canaliculitis was reported in two eyes（4.4% following punctal occlusion using thermosensitive plug（study group 1）. Spontaneous plug loss occurred in 21eyes（46.6%） in the silicone plug group（study group 2）.CONCLUSION： Improvement of subjective and objective manifestations of aqueous deficient dry eye occurs following punctal plug occlusion. Thermosensitive plug has good patient＇s compliance with fewer complications and lower rates of loss compared to the silicone plug.

Ocular surface changes in Graves’ophthalmopathy

Many patients with Graves’ophthalmopathy(GO)suffer from dry eye syndrome(DES),and this is one of the most common reasons of eye discomfort in patients with GO.The prevalence of DES in patients with GO is significantly higher than normal subjects.The ocular surface changes involving changes in tears,cornea,conjunctiva and glands occur in GO patients.However,the mechanism of how DES occurs in GO still remains unclear.In this review,the ocular surface changes were illustrated and analyzed the reasons for high prevalence of DES in GO patients.

Ocular surface and tear film changes after eyelid surgery

Eyelid surgery is widely and extensively used in facial plastic and reconstructive surgeries.There are many categories of eyelid surgeries,the most common of which include blepharoplasty,ptosis surgery,and eyelid reconstruction.In many cases,these procedures are combined,and there are many different techniques for each type of operation.Upper eyelid blepharoplasty usually includes the excision of skin,preseptal orbicularis oculi muscle,and orbital fat.Common methods of lower eyelid blepharoplasty are the skin-muscle flap,the skin flap,and the transconjunctival.Ptosis surgery is mainly divided into three types:transcutaneous,transconjunctival,and sling surgery.Surgeons often used the Hughes or Cutler-Beard Bridge Flaps in eyelid reconstruction.Different types and methods of surgery have their own advantages and disadvantages,and postoperative complications may occur.Therefore,postoperative complications of eyelid surgeries,such as dry eye symptoms,should be taken into serious consideration.Relevant literature involving these complaints can be found in PubMed by searching the terms“dry eye”,“eyelid”,“surgery”,and other related keywords.Moreover,various ocular surface and tear film alterations may be detected using the Ocular Surface Disease Index(OSDI),tear film breakup time,Schirmer test,fluorescein staining,and lissamine green staining after various eyelid surgeries.As dry eye disease is prevalent in the general population,it is more urgent to figure out what we can learn from these complaints.Further exploration in this field may help surgeons to choose a better surgical method and give an accurate evaluation of the postoperative effect.

Recent advances in ocular lubrication

The ocular lubrication,where the eyelid constantly slides on the curved corneal surface,is considered as one of primary lubrication systems in bio-tribology.Under reliable lubrication conditions,sensitive ocular tissues remain intact from fatigue damage during spontaneous blink cycles.The tear film,evenly filled between cornea and conjunctiva,is a biological fluid with dynamic adjustment ability,which provides superior lubrication with the friction coefficient of below 0.01.However,the lubrication failure may result in a variety of uncomfortable symptoms such as inflammatory reactions,tissue damage and neurological abnormalities.Therefore,it is essential to clarify the fundamental mechanism of ocular lubrication,which helps to alleviate and even recover from various ocular symptoms.This review firstly demonstrates that the ocular components,containing lipids and mucins,contribute to maintaining the lubrication stability of tear film.Furthermore,the ocular lubrication state in various physiological environments and the physical effect on tear film dynamics are further discussed.As typical applications,the therapeutic agents of dry eye syndrome and contact lens with superior lubrication effects are introduced and their lubrication mechanisms are clarified.Finally,this review summarizes a series of the latest research inspired by ocular lubrication.Overall,this work will provide a valuable guidance on the theoretical research and extensive applications in the field of biological lubrication.

Influence of electroacupuncture on histomorphology of lacrimal glands and ocular surface in experimental dry eye syndrome

Objective： To observe the influence of electroacupuncture （EA） on histomorphologies of lacrimal glands, cornea and conjunctiva in experimental dry eye syndrome, and to explore the repair effects of EA on lacrimal glands and ocular surface damage. Methods： Twenty-four healthy male New Zealand rabbits were randomly divided into a normal group, a model group, an EA group and a medication group, 6 rabbits in each group. Experimental dry eye syndrome models were prepared in rabbits by using 0.1% benzalkonium chloride for eye drops. Tear secretion volume, break-up time of tear film （BUT） and corneal fluorescein staining score were observed before and after the treatment. Periodic acid Schiff （PAS） staining method was used to observe the changes of conjunctival goblet cells in rabbits. After hematoxylin eosin （HE） staining, morphological changes of rabbit cornea, conjunctiva and lacrimal gland tissues were observed under light microscope. Results： Compared with the normal group, tear secretion volume and BUT were significantly reduced （both P^0.01）, while the corneal fluorescein staining score was significantly increased （P〈O.01） in the model group. Compared with the model group, tear secretion volume and BUT were significantly increased, while the corneal fluorescein staining score was significantly decreased in the EA group and the medication group （all P〈0.01）. Compared with the normal group, the number of conjunctival goblet cells in the model group was significantly reduced; compared with the model group, the numbers of conjunctival goblet cells were all relatively higher in the EA group and the medication group. Pathological lesions of cornea, conjunctiva and lacrimal glands all showed improvement by HE staining in the EA group and the medication group after the intervention. Conclusion： EA can improve tear secretion and tear film stability of rabbit dry eye syndrome, and repair the pathologic lesions of conjunctival goblet cells, corneal epithelia, cornea, conjunctiva and lacrimal glands.

Effects of electroacupuncture on conjunctival cell apoptosis and the expressions of apoptosis-related proteins Caspase-3,Fas and Bcl-2 in rabbits with dry eye syndrome

Objective:By observing the effects of electroacupuncture(EA)on the apoptosis of conjunctival cells of rabbits with dry eye syndrome(DES)and the expressions of apoptosis-related proteins Caspase-3,Fas and Bcl-2,to discuss the mechanism of EA in the treatment of DES from the perspective of cell apoptosis.Methods:Male New Zealand rabbits were randomly divided into a normal group(NG),a model group(MG),an EA group(EAG)and a sham EA group(SEAG).DES rabbit model was developed by eye drop of 0.1%benzalkonium chloride.The rabbit tear secretion and tear film break-up time(BUT)were measured;terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling(TUNEL)assay was used to detect the apoptosis of conjunctival cells;the expressions of Caspase-3,Fas and Bcl-2 proteins in conjunctival cells were detected by immunohistochemistry.Results:Compared with the NG,the rabbit tear secretion decreased and the BUT was shortened in the MG(both P<0.01);compared with the MG and the SEAG,the rabbit tear secretion increased and the BUT was prolonged in the EAG(all P<0.05).Compared with the NG,the apoptosis of rabbit conjunctival cells increased(P<0.01),the expressions of Caspase-3 and Fas proteins increased(both P<0.05),and the expression of Bcl-2 protein decreased(P<0.01)in the MG;compared with the MG and the SEAG,the apoptosis of rabbit conjunctival cells decreased(both P<0.01),the expressions of Caspase-3 and Fas proteins decreased(all P<0.05),and the expression of Bcl-2 protein increased(both P<0.01)in the EAG.Conclusion:EA can inhibit the apoptosis of rabbit conjunctival cells,down-regulate the expressions of apoptosis-related proteins Caspase-3 and Fas,and up-regulate the expression of Bcl-2 protein,which may be one of the mechanisms of EA in treatment of DES.

Effects of dry eye syndrome and tear film mucin treated with acupuncture

Objective To explore the therapeutic effects and mechanism of dry eye syndrome treated with acupuncture therapy. Methods Thirty cases （60 eyes） of dry eye syndrome were treated with both local and distal acupuncture. Jingrning （睛明 BL 1）, Cuanzhu （攒竹 BL 2）, Tatiyang （太阳 EX-HN 5） and Quchi （曲池 LI 11） were selected; tear secretion quantity, break up time of tear film （BUT） and expression of tear film mucin were observed before and after treatment. Results Tear secretion quantity was increased and break up time of tear film was prolonged after acupuncture therapy, indicating the significant differences （both P〈0.05）; meanwhile, the expression of tear film mucin was increased [（0.67 ± 0.1） ng vs （0.89 ± 0.23） ng, P〈0.05]. Conclusion Acupuncture can promote the expression of tear film mucin, enhance the stability of tear film and remarkably improve the symptoms of dry eye.

Summary on Clinical Experience of Acupuncture Treating Dry Eye Syndromes

Dry eye syndromes （DES） refer to discomfort in the eye region, visual disturbance, poor stability of lacrimal film, inflammation of eye surface and its potential injury due to many factors of abnormal lacrimation. Patients with this condition can experience a dry sensation in the eyes, foreign body sensation,

Diverse Needling Methods for Dry Eye Syndrome:A Randomized Controlled Study

Objective： To explore a proper acupuncture treatment protocol for dry eye syndrome （DES）, by comparing the therapeutic effects between ordinary acupuncture and electroacupuncture （EA）. Methods： Forty-seven eligible subjects with DES were randomized into an acupuncture group （n=23） and an EA group （n=24）. With the same acupoint formula, the acupuncture group was treated with ordinary acupuncture, and the EA group was treated with ordinary acupuncture plus electrical stimulation. After a treatment course, eye symptom score, Schirmer test （SIT）, Break-up Time （BUT） of tear film, Corneal Fluorescein Staining （CFS）, and Visual Analogue Scale （VAS） were adopted in evaluation and comparison of the two groups. Results： The total effective rate was 79.2% in the EA group versus 56.5% in the acupuncture group, and the difference was statistically significant （P〈0.05）. After treatment, both groups had marked improvements in eye symptom score, SIT, BUT, CFS, and VAS values （P〈0.001）; the EA group was better than acupuncture group in improving eye symptom score and SIT value （both P〈0.05）; the differences were insignificant in comparing VAS, BUT and CFS results between the two groups （P〉0.05）. Conclusion： Both EA and ordinary acupuncture are effective in treating DES, but EA is better than ordinary acupuncture in improving eye symptom and SIT score.

Acupuncture for dry eye syndrome:a meta-analysis of randomized controlled trials

Objective： To summarize and critically assess the evidence from randomized controlled trials（RCTs） of acupuncture in treating dry eye syndrome（DES） according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses（PRISMA） statement and the Cochrane Collaboration recommendations.Methods： A search of PubMed, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Embase was made from their inception to August 2016, as well as Chinese, Japanese, and Korean databases. Two reviewers independently selected RCTs and assessed the methodological quality. Meta-analysis and the level of evidence were processed by RevMan 5.3 and the Grading of Recommendations Assessment, Development and Evaluation（GRADE）approach.Results： After selection, 8 trials were subjected to our systematic review. The methodological quality was low generally.The 3-10 weeks follow-up showed that acupuncture improved the tear film break-up time（BUT）（MD=1.33, 95%CI=1.01-1.66, 619 participants）. The mean difference of Schirmer＇s test was 1.73 mm（95%CI=1.28-2.18, 618participants） between the acupuncture group and the control group. The subjective variables exhibited no significant differences.Conclusion： The low methodological quality of the trials does not suggest drawing firm conclusions on the value of acupuncture therapy for DES. Acupuncture treatment may have some effects on the tear film BUT and Schirmer＇s test,but not on the subjective symptoms. Well-planned large-scale high-quality RCTs are needed to make it clear whether acupuncture is effective in treating DES.

Efficacy observation of acupuncture for dry eye syndrome of lung-yin deficiency pattern

Objective:To observe the clinical efficacy of combining two needling manipulations,Er Long Xi Zhu(two dragons playing with a pearl)and Guo Yan Re(heat produced to reach the eyes),in treating dry eye syndrome(DES)of lung-yin deficiency pattern.Methods:Fifty-six eligible DES patients of lung-yin deficiency were randomized into an observation group and a control group,with 28 cases in each group.Same acupoints were selected in the two groups:Cuanzhu(BL 2),Sizhukong(TE 23),Taiyang(EX-HN 5)and Fengchi(GB 20)were chosen as the major points and Feishu(BL 13)and Chize(LU 5)as the adjuvant.Er Long Xi Zhu and Guo Yan Re needling manipulations were applied in the observation group while twirling reinforcing manipulation was used in the control group.Treatment was conducted once per day in both groups,for two sets of 15 consecutive days at a 2-day interval.Changes in the symptom score,tear break-up time(BUT)and tear production were observed afterwards,and the clinical efficacy was also compared between the two groups.Results:The total effective rate was 92.8%in the observation group,higher than 71.4%in the control group,and the between-group difference was statistically significant(P<0.05).After treatment,the symptom score,tear BUT and tear production showed significant improvements in both groups(all P<0.05);the symptom score,BUT and tear production in the observation group were significantly different from those in the control group(all P<0.05).Conclusion:Given the same acupoint selection,combining Er Long Xi Zhu and Guo Yan Re needling manipulations can produce more significant clinical efficacy than twirling reinforcing manipulation in treating DES of lung-yin deficiency pattern.