Chinese Herbal Medicine Ultrasonic Atomization Combined with Artificial Tears for Dry Eye Disease in Chinese Populations: A Meta-Analysis of Randomized Controlled Trials

Objective: To systematically evaluate the clinical efficacy and safety of Chinese herbal medicine ultrasonic atomization combined with artificial tears versus artificial tears alone for dry eye disease (DED) in Chinese populations. Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, and CBM for randomized controlled trials (RCTs) comparing the combination therapy with artificial tears alone in DED. Study selection, data extraction, and quality assessment were performed according to Cochrane standards. Data were analyzed using RevMan 5.4. Results: Twenty-nine RCTs involving 2520 patients were included. Meta-analysis revealed that the combination therapy significantly outperformed artificial tears alone across all efficacy outcomes: the total effective rate increased nearly 4.3-fold (OR = 4.34, 95% CI 3.24 to 5.82), clinical symptom score decreased by 0.51 points (95% CI -0.58 to – 0.44), and NEI-VFQ-25 score improved by 6.01 points (95% CI 4.72 to 7.29) (all P < 0.00001). Ocular surface function also showed significant improvements: tear secretion increased by 3.30 mm (95% CI 3.21 to 3.39), tear film breakup time prolonged by 1.92 seconds (95% CI 1.78 to 2.05), and corneal fluorescein staining reduced by 0.67 points (95% CI – 0.70 to – 0.64) (all P < 0.00001). No significant difference in adverse reactions was observed (RR = 1.04, 95% CI 0.53 to 2.05, P = 0.91). Conclusion: Chinese herbal medicine ultrasonic atomization combined with artificial tears demonstrates multiple advantages for DED in Chinese patients without increasing adverse reactions. Keywords: dry eye disease, artificial tears, chinese herbal medicine, ultrasonic atomization, meta-analysis