Laser acupuncture for dry eye and effects on the TLR4 pathway: A randomized controlled pilot trial

Dry eye disease (DED) is a prevalent condition that significantly impairs quality of life. In addition to conventional symptomatic treatments, novel therapeutic interventions such as laser acupuncture have gained increasing attention. This study was designed to evaluate the clinical efficacy of laser acupuncture for DED and its association with inflammatory biomarkers related to Toll-like receptor 4 signaling. Sixty patients (120 eyes) with symptomatic DED were randomly assigned to laser acupuncture or sodium hyaluronate eye drops. We measured subjective symptoms, tear film breakup time (BUT), tear meniscus height (TMH), corneal fluorescein staining (FL), and serum inflammatory markers. Symptoms and FL improved in both groups, but the laser acupuncture group showed greater improvements in TMH and BUT. Laser acupuncture significantly decreased pro-inflammatory NOD-like receptor family pyrin domain-containing protein 3 and increased anti-inflammatory NOD-like receptor family pyrin domain-containing protein 6 levels. These findings suggest that laser acupuncture may alleviate symptoms, improve tear film stability, and modulate circulating inflammatory biomarkers in DED, supporting further investigation of its therapeutic potential.