Although ATs supplement tear volume in DED, they are ineffective at repairing ocular surface damage or disrupting the inflammatory cascade. Some studies have reported benefits with traditional Chinese medicine (TCM) in DED.

Investigators from The Ninth Medical Center of PLA General Hospital in China sought to aggregate all data regarding the clinical utility of TCM in DED. To that end, they searched publication databases through July 2025 for relevant studies.

A total of 29 randomized controlled trials (RCTs) were included in this analysis. The studies were published between 2014 and 2024, and all were conducted in China. A subset of 23 RCTs comprising 1994 patients were eligible for the meta-analysis.

 

"…the combination therapy was superior to artificial tears alone in improving the clinical total effective rate, ocular surface function indicators, and vision-related quality of life…"

 

The TCM ultrasonic atomization plus AT intervention was associated with clinical response (odds ratio [OR], 4.34; 95% CI, 3.24-5.82; I2, 0%; P <.00001), a reduction in clinical symptom scores (mean difference [MD], -0.51; 95% CI, -0.58 to -0.44; I2, 97%; P <.00001), higher National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) score (MD, 6.01; 95% CI, 4.72-7.29; I2, 0%; P <.00001), increased Schirmer’s tear test (MD, 3.30; 95% CI, 3.21-3.39 mm; I2, 97%; P <.00001), longer tear film breakup time (MD, 1.92; 95% CI, 1.78-2.05; I2, 91%; P <.00001), and reduced corneal fluorescein staining (MD, -0.67; 95% CI, -0.70 to -0.64; I2, 97%; P <.00001) compared with AT alone.

In the subgroup analyses, the TCM intervention was associated with significant reductions in the clinical symptom domains of dryness (MD, -0.60; 95% CI, -0.87 to -0.34; P <.00001), fatigue (MD, -0.57; 95% CI, -0.64 to -0.49; P <.00001), photophobia (MD, -0.57; 95% CI, -0.73 to -0.41; P <.00001), foreign body sensitization (MD, -0.53; 95% CI, -0.55 to -0.51; P <.00001), and burning sensation (MD, -0.32; 95% CI, -0.44 to -0.20; P <.00001) and increases in general health status (MD, 7.50; 95% CI, 4.97-10.04; P <.00001), role difficulties (MD, 6.02; 95% CI, 4.10-7.93; P <.00001), and visual impairment (MD, 4.67; 95% CI, 2.27-7.05; P =.0001) of the NEI-VFQ-25 relative to AT alone.

In 4 studies that included a safety assessment, the TCM intervention was not associated with increased risk for adverse reactions relative to AT alone (relative risk [RR], 1.04; 95% CI, 0.53-2.05; I2, 0%; P =.91). The TCM ultrasonic atomization mixed with ATs was associated with ocular pruritus, ocular hyperemia, and visual disturbance.

“This study systematically evaluated the clinical efficacy and safety of ultrasonic atomization of Chinese herbal medicine combined with artificial tears in the treatment of dry eye disease,” according to the researchers. “The results indicated that the combination therapy was superior to artificial tears alone in improving the clinical total effective rate, ocular surface function indicators, and vision-related quality of life, without a significant increase in adverse events.”

This analysis is limited by the fact that different Chinese herbs were used across studies.