Dry eye disease is rarely caused by one problem alone. Tear film instability, inflammation, meibomian gland dysfunction, neurosensory abnormalities, ocular surface damage, and eyelid impairment can all contribute to the same patient’s symptoms.
A new scientific review in Contact Lens and Anterior Eye argues that periorbital transcutaneous electrical stimulation could offer a useful addition to this already crowded therapeutic landscape – particularly by targeting one under-addressed driver of dry eye: inefficient blinking.
The review, authored by Kendall E. Donaldson and Yair Manor of the Bascom Palmer Eye Institute, examines the potential role of transcutaneous electrical stimulation (TCES) applied around the periorbital area. The authors use the broad term TCES to cover a range of related technologies, including transcutaneous electrical nerve stimulation, neuromuscular stimulation, dynamic muscle stimulation, and quantum molecular resonance electrotherapy.
Normal blinking is essential for spreading tears, mucins, and meibum across the ocular surface. Spontaneous blinking is controlled by the orbicularis oculi and levator palpebrae superioris muscles, and incomplete or infrequent blinking can worsen evaporation and destabilize the tear film. And yet despite its importance, blinking remains difficult to treat directly. Exercises, digital reminders, smart glasses, and light-based cues can help some patients, but uptake and durability remain challenges.
TCES may offer a different route. In non-ophthalmic medicine, electrical stimulation has long been used for pain relief, muscle activation, blood-flow improvement, wound healing, anti-inflammatory effects, and aesthetic skin tightening. The review suggests that several of these mechanisms could be relevant to dry eye management. Periorbital TCES may improve orbicularis oculi tone, reduce lid laxity, enhance blink completeness, stimulate lacrimal or meibomian gland function, increase local microcirculation, modulate inflammation, and reduce ocular discomfort.
Several ophthalmic studies are summarized in the review. Quantum Molecular Resonance (QMR) electrotherapy has been associated with improvements in dry eye symptoms and signs, including OSDI, tear breakup time, Schirmer testing, corneal fluorescein staining, meibomian gland expressibility, meibum quality, lipid layer thickness, and tear film osmolarity. One randomized interventional study found greater improvements in non-invasive breakup time, lipid layer thickness, corneal fluorescein staining, and tear film osmolarity compared with control treatment. Another study reported reduced tear MMP-9, supporting a possible anti-inflammatory effect.
The review also highlights interferential current therapy for chronic ocular pain. Retrospective studies found subjective improvements in ocular pain and photophobia after stimulation near trigeminal nerve branches. Meanwhile, a randomized controlled trial after photorefractive keratectomy found that low-frequency periocular stimulation improved several dry eye signs, including tear breakup time, tear film osmolarity, lipid layer thickness, and staining scores, suggesting a possible role in preventing post-surgical dry eye.
Perhaps most relevant to blinking, dynamic muscle stimulation applied below the lower eyelids was reported to reduce lower lid laxity by more than 50 percent in dry eye patients, with accompanying improvements in blink quality, tear breakup time, OSDI, meibomian gland score, and corneal sensitivity.
Rather than only replacing tears or suppressing inflammation, the authors note that TCES may help restore the mechanics that keep the ocular surface stable. For a multifactorial disease, a multifaceted therapy may prove a valuable fit.
However, the authors add that the evidence base remains early.
