Why Eye Drops Are Not Enough: The Case for TCM in Dry Eye Treatment

The skeptic’s question is fair: how does a needle placed at a point on the forearm have any effect on a tear gland behind the eye? The answer lies in what acupuncture for dry eyes does to the nervous system — and the evidence is increasingly clear.

The lacrimal gland is under autonomic nervous system control. Parasympathetic stimulation drives tear secretion. Sympathetic dominance — the chronic fight-or-flight state that screen overuse, stress, and sleep deprivation produce — suppresses it.

Acupuncture has been shown in multiple studies to shift the autonomic balance toward parasympathetic dominance, directly stimulating the neural pathway that tells the lacrimal gland to produce more tears.

A clinical trial published in the journal JAMA Ophthalmology found that dry eye treatment using acupuncture was superior to artificial tears alone in improving both subjective dry eye symptoms and objective tear film stability measures, including tear break-up time and Schirmer’s test scores.

The effect persisted beyond the treatment period — unlike artificial tears, which stop working the moment you stop using them.

Acupuncture also reduces systemic and local inflammation. There are studies measuring pro-inflammatory cytokines in dry eye patients — these include IL-1β, IL-6, TNF-α, and MMP-9, all of which directly damage the corneal surface and tear-producing glands.

The studies show significant reductions in these cytokines following acupuncture treatment. The mechanism appears to involve the modulation of microRNA pathways that regulate the inflammatory cascade, particularly the miR-146a/IRAK1/JNK1 signaling axis identified in recent animal model research from Liaoning University of TCM.

There is also a direct effect on the periorbital circulation. Acupuncture at points around the eye — Jingming (BL-1), Chengqi (ST-1), Sizhukong (TE-23), Cuanzhu (BL-2) — increases local microvascular blood flow to the eyelid margin and lacrimal region. Better perfusion means better gland function.

Meibomian glands that have been slowly ischemic from years of poor circulation begin to receive the nutrients and oxygen they need to resume normal secretion.

For women in perimenopause specifically, acupuncture’s well-documented effect on the HPO axis is particularly relevant. It does not replace hormones, but it can modulate the hormonal environment in ways that support glandular function. This is a benefit that no eye drop comes close to providing.

The herbal medicine approach to dry eye operates on multiple simultaneous mechanisms. This dry eye treatment is not the same as taking a single supplement. A well-constructed Chinese herbal decoction is a multi-ingredient formula that addresses inflammation, fluid generation, corneal surface nutrition, hormonal support, and glandular repair all at once — each herb assigned as a remedy for dry eyes.

The anti-inflammatory angle.

Chronic dry eye is an inflammatory disease. The corneal surface of a dry eye patient is bathed in pro-inflammatory cytokines that progressively destroy the goblet cells responsible for mucin production, accelerating the very condition they are trying to compensate for.

Herbs like Huang Lian (Coptis chinensis) and Mu Dan Pi (Cortex Moutan) have documented anti-inflammatory activity through COX-2 inhibition and prostaglandin suppression pathways — comparable in some studies to topical non-steroidal anti-inflammatory agents, but systemic and without the corneal toxicity concerns of long-term topical NSAID use.

Huang Qin (Scutellaria baicalensis) contains baicalin, which has been shown to inhibit the NF-κB inflammatory signaling pathway — the same pathway implicated in lacrimal gland destruction in Sjögren’s syndrome and other autoimmune-driven dry eyes.

The fluid-generating and moisturizing angle.

In TCM pharmacology, a category of herbs specifically nourish what is called Yin — the body’s cooling, moistening, fluid-bearing aspect. These are not metaphorical concepts; they correspond to real physiological processes.

Mai Dong (Ophiopogon japonicus) has been extensively studied for its polysaccharide content, which has been shown to promote mucin secretion, increase goblet cell density, and improve the mucoadhesive properties of the tear film’s innermost layer. This is precisely the layer that is destroyed in chemical injury, chronic inflammation, and prolonged medication overuse — conditions where Western medicine has limited treatment options beyond surgical conjunctival transplantation.

Xuan Shen (Scrophularia nodosa) nourishes yin and clears the inflammatory heat that dry eye generates, addressing both the deficiency and its secondary consequence simultaneously.

The corneal epithelial repair and nutrition angle.

Let’s look at Huang Qi (Astragalus membranaceus), one of the most studied herbs in the Chinese medicine.

Huang Qi has well-established effects on tissue regeneration, immune modulation, and microvascular health. For the cornea specifically, Huang Qi’s astragaloside IV compounds have been shown to promote corneal epithelial cell proliferation and migration — exactly the processes needed to repair the punctate epithelial erosions that characterize moderate-to-severe dry eye.

Astragalus also upregulates growth factors involved in corneal wound healing. For patients with persistent corneal staining that does not resolve with conventional treatment, adding Astragalus to the regimen helps with repair and recovery of the eyes.

The fluid-astringing angle.

Wu Wei Zi (Schisandra chinensis) works in a way that has no direct equivalent in Western ophthalmology. Its primary action is to astringe and consolidate fluids — to prevent excessive loss of whatever fluid the body generates.

In dry eye terms, this means reducing the evaporative component of tear loss. It also has documented effects on goblet cell preservation and mucin layer stability. Interestingly, Wu Wei Zi is one of the herbs that makes herbal nebulization — delivered as warm steam directly to the open eye — particularly effective for dry eye. The herb’s active compounds arrive at the conjunctival surface at meaningful concentrations, bypassing systemic metabolism entirely, combining the pharmacological effect with the physical benefit of warm humidification.

The hormonal angle.

This is where TCM’s systemic approach shows its most significant advantage for perimenopausal and post-menopausal women. Herbs classified as kidney yin tonics — Nu Zhen Zi (Ligustrum lucidum), Gou Qi Zi (Lycium barbarum), Sang Shen (Morus fruit) — have phytoestrogenic and androgen-modulating activity that directly supports the hormonal environment needed for lacrimal and meibomian gland function.

Gou Qi Zi, in particular, contains zeaxanthin and betaine — compounds with documented neuroprotective effects on retinal ganglion cells and established roles in reducing oxidative stress in the aging eye. For women whose dry eye is clearly linked to the menopausal transition, these herbs address the hormonal root in a way that eye drops fundamentally cannot.

The meibomian gland angle.

Warming and moving herbs — used in conjunction with warm moxibustion at periorbital acupoints — directly address meibomian gland dysfunction through a mechanism that mirrors what IPL (intense pulsed light) and thermal pulsation devices achieve via physical means.

The herbal approach uses Chuan Xiong (Ligusticum chuanxiong) and Hong Hua (Carthamus tinctorius) to improve lid margin microcirculation and reduce bacterial and Demodex colonization.

For patients with significant Meibomian Gland Dysfunction (MGD), both acupuncture and herbs are really good at enhancing circulation around the eyes.

The research underpinning TCM for dry eye is no longer confined to small Chinese-language studies. The Liaoning University of TCM research group — among others — has published clinical randomized controlled trials and mechanistic animal studies in English-language journals including Experimental Eye Research and Journal of Ethnopharmacology.

Their RCT data shows that acupuncture-herbal combination therapy outperforms either modality alone on OSDI scores, tear meniscus height, and non-invasive tear break-up time.

Their animal data shows the mechanism — downregulation of the miR-146a inflammatory pathway, reduction in MMP-9, IL-1β, IL-6, TNF-α, IFN-γ, and caspase-3.

These are not vague claims about energy or balance. They are specific molecular targets that overlap substantially with what Western anti-inflammatory dry eye treatments are trying to achieve.

It is worth being clear about what integrative dry eye treatment actually means. It does not mean stopping your prescribed eye drops and replacing them with herbs. It means adding a systemic, root-addressing treatment layer to what you are already doing.

The aim is that over time, your body’s own tear-producing system recovers enough function that you become less dependent on supplementation.

Western medicine excels at managing the acute surface — lubricating eye drops, anti-inflammatory treatment.

TCM excels at rebuilding the system underneath — supporting glandular function, resolving the inflammatory cycle from within, addressing the hormonal and nutritional environment that determines whether your tear glands work well or poorly.

These are complementary strengths. Used together, they produce outcomes that neither achieves alone.

For women navigating perimenopause with worsening eye dryness, you are also likely to be  dealing with brain fog, disturbed sleep, and maybe even night sweats and other symptoms that accompany the hormonal transition.

Addressing dry eye through a hormonal lens produces improvements in overall state of your body. This is what we hope to do with TCM and acupuncture.

At Soma Clinic, we will try to gather from you a full clinical picture  — not just your eyes, but also your hormonal history, your sleep, your digestive health, and other medical conditions you may have.

Treatment typically involves in-clinic acupuncture sessions, herbal decoctions, as well as some supplemental guidance. Understand that we are working for you alongside your ophthalmologist, and that our treatments are meant to improve overall function of your eyes, amongst other things.

If you are tired of reaching for eye drops every few hours and getting nowhere, or if you sense that something more fundamental is going on than a simple lubrication problem, come and speak with us.

Book a consultation at Soma Clinic. Whether you are newly diagnosed, have been managing dry eye for years, or are entering a phase of life where your eyes are changing and you want to understand why — we are here to help you find a better way through.

Soma Clinic is located at Far East Shopping Centre, Singapore. We see women and men with dry eye and related eye conditions as part of our integrative women’s and general health practice.