I. Overview and epidemiological survey
Dry eye syndrome is a type of disease in which the tear film is unstable and the ocular surface is damaged due to abnormalities in the quantity or quality of tears, resulting in ocular discomfort. The symptoms vary according to the extent of ocular involvement, mainly including foreign body sensation, burning sensation, itching sensation, eye redness, photophobia and blurred vision, etc. In 1995, it was classified by the National Eye Institute into:
1.Insufficient tear production type: It is dry eye caused by eye gland disease or malfunction, and can be divided into syndrome-induced ocular dryness and non-syndrome-induced ocular dryness.
2.Evaporation too strong type: mainly caused by the dysfunction of the lid gland, normal tear secretion but evaporation too strong, commonly in oily skin and elderly patients.
Epidemiological clinical survey shows that 14.6% of the 2520 people in the United States who are older than 65 years old have dry eye symptoms; in Germany, 22.8% of women and 9.9% of men aged 55-59 years old have dry eye discomfort, and about 20% of women and 15% of men aged 45-54 years old have dry eye disease; in a community survey in Sweden, 705 people aged 55-72 years old have dry eye disease. people, the prevalence rate is 15%; Japan’s screening of 2127 people found 17% have dry eye symptoms; Canada 13517 people in a questionnaire survey, 28.7% have dry eye symptoms. The prevalence of dry eye was 6.1% among 1997 people aged 20-90 years old in a survey conducted by the Eye Center of Beijing Tongren Hospital. The prevalence of corneal dryness in its ophthalmology general outpatient clinic was 32.1%. In recent years, the prevalence of dry eye disease in China is increasing year by year, and to the lower age development, the incidence of “visual screen terminal syndrome” (videodisplayterminals) is higher. Poor working environment, excessive eye use and wearing of corneal contact lenses are also high risk factors for the development of dry eye.
Studies on the mechanisms of dry eye have shown in recent years that the ocular surface and the lacrimal gland are interconnected and interact as a unified whole, and that the two are interconnected through sensory (autonomic) neural reflex pathways. Normal tear production is accomplished by sensory stimulation of the ocular surface to the brain, which sends nerve impulses down to the lacrimal gland. It has been found that the decrease of plasma tear secretion and tear clearance reduces the sensitivity of the ocular surface; and the decrease of the sensitivity of the ocular surface leads to the weakening of the sensory stimulus that causes the tear secretion reflex, and the response of the tear gland to the ocular surface stimulus decreases, which further reduces tear secretion and makes dry eye worse, thus forming a self-sustaining vicious circle.
Second, the current treatment status of Western medicine
Treatment of dry eye: The overall goal is to protect the patient’s visual function, inhibit the inflammatory reaction of the ocular surface, and restore the normal structure and function of the ocular surface.
1.Medication: side effects, inaccurate efficacy, long-term use of the eye damage.
(1) Tear replacement medicine: it can increase the humidity of the eye surface, make the corneal surface smooth and increase the visual acuity. However, artificial tears cannot completely replace natural tears and contain preservatives, stabilizers and other additives, which can cause damage to the eyes with long-term use. In addition, some slow-release artificial tears have been used in clinical practice, bringing some convenience to patients.
(2) Drugs to stimulate tear secretion: the side effects are large and the exact effect is unknown.
(3) Etiological drugs: cyclosporine A and other immunomodulators, estrogens, antibiotics.
(4) Other drugs: vitamin A, autologous serum, botulinum toxin.
2.Surgical treatment: the effect is uncertain and there are certain risks.
(1) Tear replacement surgery: autologous submandibular gland transplantation, which is better than the previous parotid duct transplantation, is used to replace the role of the lacrimal gland.
(2) Tear preservation surgery: obstruction of the lacrimal duct system to delay the drainage of artificial and natural tears and to reduce the amount of tears. However, the obstruction reduces tear production, slows renewal, and diminishes ocular surface sensation. In addition, there are lid sutures to avoid corneal exposure and reduce evaporation.
Third, the advantages of acupuncture treatment
Clinical reports of acupuncture treatment for dry eye have been increasing in recent years. Acupuncture can promote tear secretion and effectively improve the stability of the tear film. In a clinical study with a larger sample, Dr. Nepp of the Institute of Ophthalmology, University of Vienna, used acupuncture therapy to better improve the signs and symptoms of dry eye disease. D., of the Department of Ophthalmology, University of Gothenburg, Sweden, used a randomized design to evaluate the efficacy of acupuncture in the treatment of dry keratoconjunctivitis. At the 3-week follow-up after 10 acupuncture sessions, patients in the acupuncture group had a much better variety of symptoms than the control group, so the authors concluded that acupuncture could be used as a routine adjunctive treatment for the disease. Eliason et al. of Virginia Commonwealth University used acupuncture alone to treat dry eye, and 88% Eliason et al. of Virginia Commonwealth University used acupuncture alone to treat dry eye, and 88% of patients showed significant improvement in the dry eye index, with greater improvement in patients under 50 years of age.
Advantages of acupuncture for dry eye.
1, no side effects: the toxic side effects of drugs and the risk of surgery can cause damage to the eyes and even affect the physiological functions of the whole body, while acupuncture treatment is called green therapy, no adverse reactions occur during the treatment process.
2, systemic regulation: acupuncture treatment not only focuses on localization, but also identifies the symptoms according to the theory of traditional Chinese medicine and the patient’s symptoms, and treats both the symptoms and the root cause with lasting effect.
3, fast results: Beijing Tongren Hospital Traditional Medicine Department has been engaged in clinical research of acupuncture treatment for dry eye for many years. In the treatment, most patients can see the effect in 1~3 times, and the symptoms are obviously improved. About 10% of patients can be clinically cured after 1~2 treatments (10~20 times). About 85% have significant improvement in symptoms and basically do not need medication. 5% of patients are ineffective and mostly have other problems, such as other diseases, poor lifestyle or work environment effects.
Experimental studies have shown that acupuncture of the Sun, Zanzhu, and Silicea points around the eye can improve the value of the ocular secretion test in 60% of New Zealand rabbits, and morphological studies have also shown that acupuncture may increase the tear synthesis and secretion function of lacrimal gland tissue.
Problems exist and need to be addressed.
1, Due to the characteristics of dry eye, most patients require long-term treatment.
2.Dry eye is affected by many factors and the cure rate is low.
3, comprehensive treatment is needed, acupuncture, moxibustion, puncture and bloodletting, etc.
Fourth, the action plan of acupuncture treatment
Treatment of dry eye removing the cause while controlling the symptoms and progression of the disease early is the key. The aim is to select a treatment that can effectively control the progression of the disease, improve visual acuity, and restore the normal ocular surface physiological structure.
Therefore, comprehensive treatment and individualized protocols are the basic principles of acupuncture treatment.
The anatomical structure of the local points of the eye is emphasized:The sensory nerve of the lacrimal gland is the ophthalmic meridian of the first branch of the trigeminal nerve, which divides into three branches behind the superior orbital fissure, one being the lacrimal nerve, which enters the orbit and travels to the superior lateral part of the external rectus. The nerve controlling the lacrimal gland starts from the superior salivary nucleus of the reticular formation of the medulla oblongata and follows the yandai nerve of the facial nerve.
Acupuncture point selection: the main points are: pupil s, eyelid, and sizhukong
The pupil s point is located next to the outer canthus of the eye, when the lateral edge of the orbit is located. It is under the orbicularis oculi muscle and deep in the temporalis muscle; at the distribution of the zygomatic-orbital arteries and veins; and is covered with the zygomatic-facial and zygomatic-temporal nerves, the frontotemporal branch of the facial nerve.
The eyelid point is in the recess slightly above the inner canthus of the eye. The deeper part of the point has the inner canthus artery and vein, and above the deeper part is the ophthalmic artery and vein proper. It is distributed by the superior and inferior talocrine nerves, and the deeper layers are the oculomotor nerve and the ophthalmic meridian.
The Silhouette point is in the lateral recess of the eyebrow tip. The deeper layers of the point are distributed by the supraorbital and zygomaticofacial nerves. The supraorbital nerve is a branch of the first branch of the trigeminal nerve (ophthalmic meridian), which runs through the supraorbital notch or supraorbital foramen to the subcutaneous frontal area and is distributed subcutaneously on the top of the forehead. The zygomatic-facial nerve is a branch of the second branch of the trigeminal nerve (maxillary nerve), which is distributed in the skin of the cheek.
Acupuncture treatment can also be combined with modern medical methods that have some effect.