A randomized, double-masked study to evaluate the effect of omega-3 fatty acids supplementation in meibomian gland dysfunction Prevalence of dry eye syndrome among US women. Relation between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women. Pilot, Prospective, Randomized, Double-masked, Placebo-controlled Clinical Trial of an Omega-3 Supplement for Dry Eye [Oral flaxseed oil (Linum usitatissimum) in the treatment for dry-eye Sjögren's syndrome patients]. Effects of dietary supplementation with fish oil on dry eye syndrome subjects: randomized controlled trial. A randomized controlled trial of omega-3 fatty acids in dry eye syndrome. Systemic Linoleic and &ggr;-Linolenic Acid Therapy in Dry Eye Syndrome With an Inflammatory Component Epithelial Healing and Visual Outcomes of Patients Using Omega-3 Oral Nutritional Supplements Before and After Photorefractive Keratectomy: A Pilot Study Short-term consumption of oral omega-3 and dry eye syndrome.
Background Dysfunction of the meibomian gl and ( MG ) is among the most frequent causes of ophthalmological symptoms . The inflammation seen in meibomian gl and dysfunction ( MGD ) is part of its pathogenesis , and evidence of the antioxidant-inflammatory properties of omega-3 fatty acids suggests this to be an appropriate treatment for MGD . Objective We aim ed to assess the effectiveness of omega-3 fatty acids versus placebo , in improving the symptoms and signs of MGD . Methods We conducted a r and omized and double-mask trial of 3 months duration . We enrolled 61 patients who presented with symptomatic MGD and no tear instability ( defined as tear breakup time [ TBUT ] < 10 seconds ) . Participants were r and omly assigned to two homogeneous subgroups . For patients in group A , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus a placebo oral agent . For patients in group B , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus oral supplementation with omega-3 fatty acids . We performed the following tests : ( 1 ) TBUT ; ( 2 ) Schirmer I test ; ( 3 ) Ocular Surface Disease Index © ( OSDI © ; Allergan , Inc. , Irvine , CA , USA ) ; ( 4 ) MG expression ; ( 5 ) evaluation of lid margin inflammation ; and ( 6 ) interpalpebral and corneal dye staining . Results After 3 months of evaluation , the mean OSDI , TBUT , lid margin inflammation , and MG expression presented improvement from the baseline values , in group B ( P < 0.01 , P < 0.001 , P < 0.0001 , P < 0.0001 , respectively ) . The Schirmer test results were also improved and statistically significant ( P < 0.01 ) . Conclusion Oral omega-3 fatty acids , 1.5 grams per day , may be beneficial in the treatment of MGD , mainly by improving tear stability PURPOSE Dry eye syndrome ( DES ) is believed to be one of the most common ocular problems in the United States ( US ) , particularly among older women . However , there are few studies describing the magnitude of the problem in women and how this may vary with demographic characteristics . DESIGN Cross-sectional prevalence survey . METHODS STUDY POPULATION we surveyed 39,876 US women participating in the Women 's Health Study about a history of diagnosed DES and dry eye symptoms . MAIN OUTCOME MEASURE we defined DES as the presence of clinical ly diagnosed DES or severe symptoms ( both dryness and irritation constantly or often ) . We calculated the age-specific prevalence of DES and adjusted the overall prevalence to the age distribution of women in the US population . We used logistic regression to examine associations between DES and other demographic factors . RESULTS The prevalence of DES increased with age , from 5.7 % among women < 50 years old to 9.8 % among women aged > or = 75 years old . The age-adjusted prevalence of DES was 7.8 % , or 3.23 million women aged > or = 50 in the US . Compared with Whites , Hispanic ( odds ratio [ OR ] = 1.81 , confidence interval [ CI ] = 1.18 - 2.80 ) and Asian ( OR = 1.77 , CI = 1.17 - 2.69 ) women were more likely to report severe symptoms , but not clinical ly diagnosed DES . There were no significant differences by income ( P([trend ] ) = .78 ) , but more educated women were less likely to have DES ( P([trend ] ) = .03 ) . Women from the South had the highest prevalence of DES , though the magnitude of geographic differences was modest . CONCLUSIONS Dry eye syndrome leading to a clinical diagnosis or severe symptoms is prevalent , affecting over 3.2 million American women middle-aged and older . Although the condition is more prevalent among older women , it also affects many women in their 40s and 50s . Further research is needed to better underst and DES and its impact on public health and quality of life BACKGROUND Dry eye syndrome ( DES ) is a prevalent condition , but information on risk or protective factors is lacking . OBJECTIVE We aim ed to determine the association between the dietary intake and ratio of n-3 and n-6 fatty acids ( FAs ) and DES occurrence . DESIGN Of the 39876 female health professionals in the Women 's Health Study ( WHS ) , 32470 women aged 45 - 84 y who provided information on diet and DES were cross-sectionally studied . We assessed FA intakes by using a vali date d food-frequency question naire and assessed  DES  by using self-reports of clinical ly diagnosed cases . Of the sample , 1546 ( 4.7 % ) subjects reported DES .  We used logistic regression models to estimate the odds ratios ( ORs ) and 95 % CIs to describe the relation of FA intake with DES . RESULTS After adjustment for demographic factors , hormone therapy , and total fat intake , the OR for the highest versus the lowest quintile of n-3 FAs was 0.83 ( 95 % CI : 0.70 , 0.98 ; P for trend = 0.05 ) . A higher ratio of n-6 to n-3 FA consumption was associated with a significantly increased risk of DES ( OR : 2.51 ; 95 % CI : 1.13 , 5.58 ) for > 15:1 versus < 4:1 ( P for trend = 0.01 ) . In addition , tuna consumption [ 1 serving was 113 g ( 4 oz ) ] was inversely associated with DES ( OR : 0.81 ; 95 % CI : 0.66 , 0.99 for 2 - 4 servings/wk ; OR : 0.32 ; 95 % CI : 0.13 , 0.79 for 5 - 6 servings/wk versus < or = 1 serving/wk ; P for trend = 0.005 ) . CONCLUSIONS These results suggest that a higher dietary intake of n-3 FAs is associated with a decreased incidence of  DES in women . These findings are consistent with anecdotal clinical observations and postulated biological mechanisms Purpose : To investigate the potential effect of dietary supplementation with omega-3 fatty acid on lipid composition of meibum , aqueous tear evaporation , and tear volume in patients with dry eye . Methods : In a pilot , prospect i ve , r and omized , double-masked study , patients with dry eye received a daily dose of fish oil , containing 450 mg of eicosapentaenoic acid , 300 mg of docosahexaenoic acid , and 1000 mg of flaxseed oil ( TheraTears Nutrition ; Advanced Vision Research , Woburn , MA ) for 90 days . There were 2 patient visits : baseline and final . At these visits , patients completed the ocular surface disease index to score subjective symptoms , and slit-lamp examinations , breakup time , corneal staining , Schirmer type I , fluorophotometry , evaporometry , and collection of meibomian gl and secretion sample s for lipid composition analysis were performed . Results : A total of 36 patients with dry eye completed the study . At the end of the study , 70 % of the patients became asymptomatic , whereas for the placebo group , 7 % of the symptomatic patients became asymptomatic . Schirmer testing and fluorophotometry suggested that the omega-3 supplement increased tear secretion . The lipid composition of the sample s collected from the omega-3 group was found to be very similar to that from the placebo group . No trends between groups were seen for other objective parameters . Conclusions : Dietary supplementation with omega-3 fatty acids in dry eye showed no significant effect in meibum lipid composition or aqueous tear evaporation rate . On the other h and , the average tear production and tear volume was increased in the omega-3 group as indicated by both Schirmer testing and fluorophotometry PURPOSE To evaluate if oral flaxseed oil ( Linum usitatissimum ) , which reduces the inflammation in rheumatoid arthritis , may help keratoconjunctivitis sicca 's treatment in Sjögren 's syndrome patients . METHODS In a r and omized clinical trial , 38 female patients with rheumatoid arthritis or systemic lupus erithematosus associated with keratoconjunctivitis sicca and Sjögren 's syndrome were consecutively selected from patients of the Department of Rheumatology of the Amazonas University Hospital . Keratoconjunctivitis sicca diagnosis was based on a dry-eye symptom survey score ( Ocular Surface Disease Index - OSDI ) , Schirmer-I test , fluorescein break-up time , 1 % Rose Bengal staining of ocular surface measured by the van Bijsterveld scale .  All patients had ocular surface inflammation evaluated and quantified by conjunctival impression cytology , before and after the study . The subjects were divided into three groups with 13 ( Group I ) , 12 ( Group II ) and 13 ( Group III ) patients . Group I received flaxseed oil capsules with a final 1 g/day dosis , Group II flaxseed oil capsules with a final 2 g/day dosis and Group III - controls - placebo , for 180 days . RESULTS Comparing the results at the beginning and at the end of the treatment , statistically significant changes ( p<0.05 ) in symptoms ( OSDI ) , ocular surface inflammation quantified by conjunctival impression cytology , Schirmer-I test and fluorescein break-up time occurred in Groups I e II when compared to controls . CONCLUSIONS Therapy with oral flaxseed oil capsules 1 or 2 g/day reduces ocular surface inflammation and ameliorates the symptoms of keratoconjunctivitis sicca in Sjögren 's syndrome patients . Long-term studies are needed to confirm the role of this therapy for keratoconjunctivitis sicca in Sjögren 's syndrome The purpose of this study was to evaluate the efficacy of fish oil supplementation added to usual dry eye treatment in dry eye subjects in a r and omized controlled trial . Twenty-seven typical dry eye subjects were selected from 43 c and i date s by the diagnostic criterion for dry eye in this study . They were assigned to the r and omized fish oil group ( n = 15 ) or the placebo group ( n = 12 ) . Fish oil group ingested fish oil capsules containing eicosapentaenoic acid ( EPA , 1245 mg/day ) and docosahexaenoic acid ( DHA , 540 mg/day ) for 12 weeks . Placebo group ingested placebo capsules without EPA or DHA . A visual analog scale test estimating subjective symptoms , the Schirmer I test , tear film break-up time ( BUT ) measurement , fluorescein staining , and rose bengal staining were performed every 4 weeks during the 12-week supplementation period and 4-week washout period . The subjective symptom of " eye pain " , BUT , and changes in rose bengal staining score of the fish oil group were significantly improved after 8 - 12 weeks of supplementation and /or 4 weeks of washout , compared to those of the placebo group . These results suggest that fish oil supplementation added to usual care may be effective in the treatment of dry eye AIM To evaluate the role of dietary supplementation of omega-3 fatty acids in dry eye syndrome . METHODS A prospect i ve , interventional , placebo controlled , double blind r and omized trial was done at two referral eye centers . Two hundred and sixty-four eyes of patients with dry eye were r and omized to receive one capsule ( 500 mg ) two times a day containing 325 mg EPA and 175 mg DHA for 3 months ( omega-3 group ) . The omega-3 group was compared to a group of patients ( n=254 ) who received a placebo ( placebo group ) . There were 4 patient visits ( at baseline , 1 month , 2 months and 3 months ) . On each visit , recording of corrected distance visual acuity ( CDVA ) , slit lamp examination and question naire based symptom evaluation and scoring was done . A symptomatic score of 0 - 6 was mild , 6.1 - 12 moderate and 12.1 - 18 severe dry eye . Response to intervention was monitored by routine tear function tests like Schirmer I test , tear film break-up time ( TBUT ) , Rose Bengal staining and most notably , conjunctival impression cytology . RESULTS Sixty-five percent of patients in the omega-3 group and 33 % of patients in placebo group had significant improvement in symptoms at 3 months ( P=0.005 ) . There was a significant change in both Schirmer 's test value and TBUT values in the omega-3 group ( P<0.001 ) , both comparisons . However , there was a larger drift in TBUT values in omega-3 than the placebo group , in comparison to Schirmer 's test values . The mean TBUT score was 2.54±2.34 in the omega-3 group and 0.13±0.16 in placebo group , respectively . The mean reduction in symptom score in omega-3 group was 2.02±0.96 as compared to 0.48±0.22 in placebo group ( P<0.001 ) . Despite a slight increase mean score , the Schirmer scores did not correlate well with symptomatic improvement . CONCLUSION Omega-3 fatty acids have a definite role for dry eye syndrome . The benefit seems to be more marked in conditions such as blepharitis and meibomian gl and disease . The role of omega fatty acids in tear production and secretion needs further evaluation Purpose . To evaluate the efficacy and anti-inflammatory activity of systemic linoleic ( LA ) and & ggr;-linolenic acid ( GLA ) , which decrease chronic inflammation in rheumatoid arthritis , on the ocular surface of patients with keratoconjunctivitis sicca . Methods . In a r and omized clinical trial , 26 patients with aqueous-deficient keratoconjunctivitis sicca were consecutively selected from patients presenting to Department of Neurosciences , Ophthalmology and Genetics , University of Genoa . The diagnosis was based on dry  eye  symptom survey score , Schirmer-1 test values , positive vital staining with lissamine green , and fluorescein break-up time ( FBUT ) . All patients had ocular surface inflammation based on HLA-DR expression , a major histocompatibility class II antigen , on epithelial bulbar conjunctiva sample s. The subjects were r and omly divided into two groups of 13 patients each . The study group received tablets containing LA ( 28.5 mg ) and GLA ( 15 mg ) twice daily for 45 days and used tears ; the control group received a tear substitute and a placebo tablet for 45 days . Results . Statistically significant changes in symptoms ( p < 0.005 ) , lissamine green staining ( p < 0.005 ) , and ocular surface inflammation ( p < 0.05 ) occurred in the study group compared with controls . HLA-DR expression varied from 58.5 ± 14.1 % positive conjunctival cells to 41.3 ± 18.9 % in the treated group and from 61.4 ± 21.9 % to 58.0 ± 13.3 % in the controls . No statistically significant difference between groups was found for FBUT and the Schirmer-1 test . Conclusions . Therapy with LA and GLA and tear substitutes  reduces ocular surface inflammation and improves dry eye symptoms . Long-term studies are needed to confirm the role of this new therapy for keratoconjunctivitis sicca Purpose : To investigate the effect of omega-3 oral nutritional supplementation on corneal reepithelialization , visual acuity , and tear stability  after photorefractive keratectomy ( PRK ) . Methods : This is a prospect i ve , r and omized , single-blinded controlled therapeutic trial using omega-3 oral nutritional supplements ( TheraTears Nutrition for Dry Eyes ; Advanced Vision Research —Akorn , Ann Arbor , MI ) conducted at our center . Eighteen healthy patients with refractive error between −1 and −8 diopters were recruited and had bilateral PRK . The treatment group ( n = 9 subjects ) received omega-3 2 weeks before surgery through 1 month after PRK . The control group ( n = 9 subjects ) was not given omega-3 . Epithelial defects were photographed on postoperative days 0 to 5 . Reepithelialization ( area in square millimeters ) was assessed by fluorescein staining until healing . Tear breakup time ( TBUT ) and uncorrected distance visual acuity were measured at 1 week , and 1 and 3 months postoperatively . Results : Epithelial defect in the treatment group eyes healed faster compared with that of the controls ( P = 0.04 ) . The treatment group eyes healed at an average rate of 1.19 % [ SD = 0.002 ; 95 % confidence interval ( CI ) , 1.04%–1.34 % ] per hour , versus 0.83 % ( SD = 0.0008 ; 95 % CI , 0.77%–0.89 % ) for controls ( Mann – Whitney rank-sum test , P < 0.001 ) . The treatment group eyes maintained a significantly longer TBUT from week 1 through 3 months ( mean = 9.52 seconds , SD = 0.81 ; 95 % CI , 8.93–10.10 ) , compared with the controls ( mean = 5.52 seconds , SD = 0.81 ; 95 % CI , 4.93–6.10 ; P < 0.001 ) , and all reached 20/20 vision versus only 4 in the control group 1 month after surgery ( P = 0.03 ) . Conclusions : Omega-3 oral nutritional supplements  decreased the average time for epithelial healing , and improved TBUT and visual acuity recovery in PRK . These findings suggested that omega-3 oral nutritional supplementation may be a beneficial adjunct therapy for PRK patients PURPOSE To assess the effect of oral omega-3 fatty acids on tear break-up time ( TBUT ) , Schirmer 's score , and Ocular Surface Disease Index ( OSDI ) through a double-blind clinical trial . DESIGN R and omized , double-blind clinical trial . PARTICIPANTS Sixty-four patients with dry eye symptoms between the ages of 45 and 90 years were r and omized into 2 groups : 33 persons in the treatment group and 31 persons in the placebo group . METHODS The treatment group received 2 capsules of omega-3 ( each containing 180 mg eicosapentaenoic acid [ EPA ] and 120 mg docosahexaenoic acid [ DHA ] ) daily for 30 days , and the placebo group received 2 medium-chain triglyceride oil capsules daily for 1 month . The outcomes were measured 1 month after the intervention . MAIN OUTCOME MEASURES The primary outcome measure was an increase from baseline in TBUT at day 30 . Secondary outcome measures were a decrease from baseline in the OSDI score and an increase in the Schirmer 's score at day 30 . RESULTS In the placebo group , before the intervention , the mean TBUT , OSDI , and Schirmer 's scores were 4.5 ± 2.1 seconds , 36.4 ± 13.8 , and 6.0 ± 2.6 mm , respectively , and 1 month later were 4.7 ± 2.6 seconds , 37.6 ± 13.5 , and 6.2 ± 2.5 mm , respectively . In the treatment group , these values were 3.9 ± 1.7 seconds , 38.7 ± 16.5 , and 5.8 ± 2.5 mm before the intervention and 5.67 ± 2.6 seconds , 29.3 ± 15.9 , and 6.8 ± 2.8 mm after the intervention , respectively . Repeated- measures analysis of variance showed that improvements in TBUT , OSDI , and Schirmer 's scores were significantly better in the treatment group than in the placebo group . The changes in the treatment and placebo groups were 71 % and 3.3 % for TBUT ( P < 0.001 ) , 26 % and 4 % ( P=0.004 ) for dry eye symptoms , and 22.3 % and 5.1 % for Schirmer 's score ( P=0.033 ) , respectively . CONCLUSIONS This study demonstrated that oral consumption of omega-3 fatty acids ( 180 mg EPA and 120 mg DHA twice daily for 30 days ) is associated with a decrease in the rate of tear evaporation , an improvement in dry eye symptoms , and an increase in tear secretion
Background Dry eye is a common , complex condition that can reduce ocular comfort and visual performance .
The impact on quality of life has been rated as similar to the effect of moderate angina and , in more severe cases , dialysis and severe angina .
This study aim ed to use meta- analysis to compare omega-3 fatty acid and placebo fatty acid in the management of dry eye syndrome .