**Background:** Dry eye syndrome (DES) is a chronic inflammatory ocular surface disease with increasing prevalence (21–30% in China). Current treatments like artificial tears (AT) provide limited benefit, and surgical options are costly. Acupuncture (AC) has shown potential therapeutic value for DES. This systematic review and meta-analysis aimed to evaluate the evidence for the efficacy of AC combined with AT in treating DES.
**Methods:** A systematic search of PubMed, Cochrane Library, Web of Science, Chinese Scientific Journal Database, China National Knowledge Infrastructure, and Wanfang Data was conducted from database inception to July 1, 2023. Inclusion criteria: randomized or controlled trials; patients meeting DES diagnostic criteria (BUT <10 seconds, SIT <10 mm/5 min); trial group receiving AC+AT; control group receiving AT alone. Exclusion criteria: noncontrolled studies; specific ocular conditions; poor quality; duplicate publications; reviews; animal studies. Two authors independently extracted data. Primary outcomes: BUT and SIT. Secondary outcomes: CFL, OSDI, clinical efficacy, inflammatory markers (IL-6, TNF-α). Meta-analysis used Review Manager 5.3 with SMD or OR and 95% CI; fixed-effects model for homogeneity (P>.1 or I²<50%), random-effects otherwise.
**Key Results:** Sixteen studies (1383 patients) were included. BUT significantly improved in AC+AT vs AT [SMD=1.25, 95% CI (1.14, 1.37), P<.0001; I²=93%]. SIT also significantly improved [SMD=1.55, 95% CI (1.08, 2.02), P<.0001; I²=94%]. CFL was significantly reduced [SMD=−2.08, 95% CI (−2.96, −1.20), P<.00001; I²=96%]. OSDI showed no significant difference (P=.15; I²=97%). Inflammatory markers: IL-6 (P<.0001) and TNF-α (P<.00001) were significantly reduced in the AC+AT group. Overall efficacy rate was significantly higher in AC+AT [OR=4.09, 95% CI (3.04, 5.51), P<.00001; I²=0%]. Adverse events: 5 dropouts in Sun 2022 (2 in AC+AT due to personal reasons); 8 dropouts in Wang 2021 (5 in AC+AT, 1 due to fainting); 17 dropouts in Kim 2012 (3 hematomas in AC group).
**Clinical Implications:** Acupuncture combined with artificial tears appears to be a safe and effective complementary therapy for dry eye syndrome, improving tear film stability, tear secretion, corneal epithelial integrity, and reducing ocular surface inflammation. The lack of significant improvement in OSDI suggests that subjective symptoms may not fully align with objective measures. Limitations include small sample sizes, variable study quality, short follow-up, and high heterogeneity. Larger, longer-term, high-quality RCTs are needed to confirm these findings and standardize acupuncture protocols.