Effects of Traditional Chinese Medicine for Prevention and Management of Dry Eye Disease: A Systematic Review, Network Meta-Analysis and Meta-Regression of Randomized Controlled Trials

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Abstract
Dry eye disease (DED) is a prevalent ocular surface disorder with diverse clinical presentations, yet the comparative efficacy of various Traditional Chinese Medicine (TCM) formulations remains unclear. This systematic review and network meta-analysis evaluated the comparative effects and baseline response relationships of TCM classes for DED across 33 randomized controlled trials retrieved from PubMed, Embase, Cochrane Library, CINAHL, and CNKI. Primary outcomes included Schirmer I test (SIT), tear film break-up time (TBUT), and corneal fluorescein staining (FL). Random-effects models estimated weighted mean differences (WMD) with 95% credible intervals (CrIs); for FL, which was measured on heterogeneous grading scales and standardized mean differences (SMD) were used. TCM classes exhibited outcome-specific profiles: Yin–Kidney (YK) and Qi–Yin Support (QYS) produced the greatest improvements in SIT versus standard care (YK: WMD 2.56, 95% CrI 0.25 to 4.86; QYS: WMD 5.32, 95% CrI 0.63 to 10.06) and significantly improved TBUT (YK: WMD 2.04, 95% CrI 1.12 to 2.89; YM: WMD 2.49, 95% CrI 0.64 to 4.37). YK demonstrated the greatest FL reduction (SMD −0.37, 95% CrI −0.71 to 0.00), followed by Liver–Spleen Regulating (SMD −0.30, 95% CrI −0.99 to 0.39). Meta-regression revealed that patients with more severe baseline deficits in tear secretion (lower SIT) and more extensive ocular-surface damage (higher FL) achieved greater clinical improvements, whereas baseline of TBUT did not significantly moderate treatment response. Overall, TCM serves as an effective adjunctive therapy for DED, with selection guided by clinical pattern and target outcomes.

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