EDITORIAL

ACUPUNCTURE IN DRY EYE SYNDROME

ACUPUNTURA EN EL SÍNDROME DE OJO SECO

JOHANNES NEPP, MD¹

Dry eyes often are treatment is unsatisfying. Medical science searches the best medication; patients seek alternative medical treatments, which promise better influences.

Because of special experiences we have tried acupuncture. But what is the background of this ancient method especially in dry eyes?

First empirical trials with acupuncture treatment were done in patients, who did not respond on any kind treatments with artificial tears.

There did not exist any literature about acupuncture in dry eyes, only Chinese traditional medical educations, based on a philosophy which connects symptoms with 5 elements and 8 principals, without exact analysis of the medical problems. And there were descriptions of points, but without exact analysis of the disease. TCM speaks from a weakness of the liver-yin which is to be translated as a kind of weakness with pale skin and e.g. dryness in mucosa like conjunctiva or throat (There is no change within the organ liver). There were studies neither of the outcome after acupuncture nor of adversative effects (1).

The mean target of acupuncture is the subjective feeling which can be treated in every kind of illness.

Our interpretation was, that there exist functional disorders, which may change in dependence to the strain: In times of stress there are more symptoms, in time of relaxation there are less symptoms.

And that a positive effect on Schirmers test and break up time and usage of artificial tears. The observed effect was up to one year in younger patients (Nepp 1992 and Wedrich 1996).

Acupuncture had better effects in patients with disorders, in psychic and functional troubles, less effects in morphological determinations, like Sjögren-Syndrom (2).

Takeuchi et al reported of influence on tearing system in healthy subjects, but there was also an adversative effect on the heart rate and the pupillary myosis (3).

Therefore we supposed that there is a general effect on the vegetative system.

In a double blind study the changes in pupil reaction and habituation could be seen after acupuncture.

The outcome showed a sympathetic tension like in stress before acupuncture which seem to cause the dry eye symptoms, and after acupuncture there was a decrease of this tension in combination with the improvements of clinic signs of dryness (Nepp 2003).

Another study was performed to evaluate the temperature changes and it was proven, that the temperature of the skin increased slightly as the temperature of the ocular surface decreased in dependence to the increased tear flow measured with Schirmers test (4).

Other studies have been performed about the decreased pain in dry eyes (Nepp 1999).

But there was more than the influence in pain, which is based on changes of neurotransmitters.

After acupuncture many patients report from calmness and better conditions.

The question was, if there is a psychic cause of dry eyes and if there is an influence of acupuncture on this problem.

Mansila reported from histeria in dry eye patients (Mansila 1907) and Erb described psychic problems by records. In comparison to a control group the patients with dry eyes showed significantly more complaints (Zerssen Symptom List), were more emotionally unstable (MPI-N) and more depressive (BDI). No group differences were found regarding extroversion-introversion (MPI-E). An additional psychological treatment (e.g. autogenic training) was recommended for these patients to stabilize their emotional condition, to have a positive effect on dry eye problems (5).

A recent (unpublished) study was performed to show effects on these parameters.

Patients reported from a stabilization of their emotions, they were less depressive patients and had less complaint (Nepp Madrid 2005, Congress of the ISD).

In conclusion we can use acupuncture as a additional tool especially to influence the psychic and vegetative tension in patients with dry eye symptoms.

But the hope especially of patients to have a kind of magic we have to negate: there are effects, critically small effects, which have an influence on the lachrymal system. But a treatment without ophthalmologic observations or local treatments have to be done as well.

¹ Department of Ophthalmology. Medical University Vienna. Vienna. Austria.
E-mail: johannes.nepp@meduniwien.ac.at

REFERENCES

1. Francini S, Poletti J. Conjunctivitis. In: Francini S. Ophthalmologie en medecine traditionelle chinoise et acupuncture. Paris: Maloine Ed; 1986; 121-125.

2. Nepp J, Derbolav A, Haslinger-Akramian J, Mudrich C, Schauersberger J, Wedrich A. Effect of acupuncture in keratoconjunctivitis sicca. Klin Monatsbl Augenheilk 1999; 215: 228-232.

3. Takeuchi K, Ikemoto K, Suzuki T, Fukozao M, Miyamoto T, Nakano H. The effect of acupuncture stimulation on tear secretion. Folia Ophthalmol Jpn 1996; 47: 1185-1188.

4. Nepp J, Tsubota K, Goto E, Schauersberger J, Schild G, Jandrasits K, et al. The effect of acupuncture on the temperature of the ocular surface in conjunctivitis sicca measured by non-contact thermography: preliminary results. Adv Exp Med Biol 2002; 506: 723-726.

5. Erb C, Horn A, Gunthner A, Saal JG, Thiel HJ. Psychosomatic aspects of patients with primary keratoconjunctivitis sicca. Klin Monatsbl Augenheilkd 1996; 208: 96-99.