An increasing wealth of evidence now suggests that a diet rich in omega-3 fatty acids may help eliminate the signs and symptoms of dry eye.1 Omega-3 fatty acid supplementation has demonstrated improved Schirmer test scores, tear film break-up time, fluorescein staining and lissamine green staining in patients who present with mild to moderate dry eye.2-5
In addition to combating dry eye, increased omega-3 intake has shown other ocular health benefits, such as a lower incidence of age-related macular degeneration and nuclear cataracts.6-10
Most of us typically get a sufficient amount of omega-6 fatty acids from the foods we regularly eat; however, we often do not consume enough foods rich in omega-3s, such as salmon, herring, sardines, trout, mackerel and other cold-water fish.
Cold-water fish and fish oil supplements contain both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), natural anti-inflammatory agents that are vital for healthy brain development and retinal function.7,8
Fish oil supplements also help to increase high-density lipoprotein (HDL) levels and decrease low-density lipoprotein (LDL) levels. Omega-3 fatty acids not only help to prevent plaque from forming in arteries, but also remove existing plaque build-ups. In fact, the U.S. Food & Drug Administration has recently announced that drug labels on fish oil capsule vials should indicate that omega-3 supplements protect against heart disease.
Fish Oil and Dry Eye
Other than general problems associated with poor visual acuity, dry eye is the most frequent patient complaint that optometrists hear. Women are nine times more prone to dry eye than men, and members of both sexes are increasingly predisposed to dry eye with advanced age.4,11 Recent literature has linked dry eye to a chronic, low-grade inflammation of the meibomian and/or lacrimal gland.11,12
The EPA in fish oil suppresses this inflammation and dramatically reduces the gritty irritation that patients with meibomitis experience upon waking in the morning. It also protects the lacrimal gland by blocking apoptosis, which restores lacrimal gland function and inhibits secondary inflammation of the ocular tissue.11,12
EPA generates the anti-inflammatory eicosanoids prostaglandin E3 and leukotriene B5, and it blocks the delta-5 desaturase enzymatic step that stops the conversion of omega-6 EFAs to the inflammatory cascade of arachidonic acid (AA). This allows for additional conversion to anti-inflammatory prostaglandin E1 (PGE1). PGE1 then binds to EP2 and EP4 receptors to activate adenylate cyclase and increase cyclic AMP, which in turn stimulates tear production. The dietary increase in omega-3 EFAs has also been shown to improve meibomian gland dysfunction with a thinner and clearer meibomian gland secretion.13
As previously noted, omega-3 fatty acid is a natural anti-inflammatory that exhibits no side effects. Omega-3s help repair our bodies by fighting chronic inflammation that can adversely affect our eyes, heart, blood vessels, joints and skin. Much like an oil change helps an engine run more smoothly by cutting down on friction, omega-3s can “re-oil” parts of our bodies that have worn down over time.
The friction of contact lenses on the cornea can cause an inflammatory reaction. Refractive procedures can also cause inflammation. Low-grade corneal inflammation may result from autoimmune diseases, allergies and sinusitis. Anti-histamines and diuretics can cause or increase dry eyes.
Time can cause wear and tear on our body—especially on those parts that receive constant use. As we age, bodily production of some enzymes and hormones slows. Accordingly, regeneration of bodily cells slows as well.
Chemicals that we ingest, that are rubbed on our skin, or that we are exposed to in the air can clog parts of our system and cause negative reactions, such as inflammation and infection.
These reactions cause increased blood flow, which brings nutrients and white blood cells to the trouble area to combat unwelcome pathogens and transport away waste and debris.
Many pharmaceuticals are available to help quell inflammation, but none of them enable the body to do its own repair work. Also, anti-inflammatory medications do not prevent such irritation from recurring. Further, many pharmaceuticals demonstrate one or more negative side effects because these agents are a foreign substance to the body.
Clearly, certain natural remedies may exhibit minor side effects as well. For best results, never exceed the recommended dosage of any nutraceutical. Also, if your patients demonstrate a known allergy to fish, do not recommend omega-3 fish oil supplements.
Natural therapy means that the body is brought into contact with a restorative substance that it easily recognizes. This is why fish oil can help the body eliminate or arrest symptoms of dry eyes, arthritis, heart disease and many other inflammatory conditions.
Of course, management of acute conditions requires pharmaceuticals. But, when acuteness recedes, natural therapies are required to help prevent recurrence.
It is a good idea to take appropriate nutraceuticals for any condition that you might be prone to based on age, family history or prior/current maladies.
Why wait? You already know the old saying about an ounce of prevention…
How Much is Required?
As a general rule, everyone (including children and teenagers) should take 1,000mg of omega-3 fish oil once a day. Pregnant women and individuals over 40 years of age particularly benefit from omega-3 supplementation. Omega-3 fish oil capsules are as necessary as daily vitamin/mineral supplements to help keep the body running smoothly.
Increase the dosage as needed to help treat inflammatory conditions. Take 1,000mg of fish oil with food t.i.d. to alleviate dry eye.7 For arthritis, consume at least four 1,000mg capsules per day.7 Also, be certain that each capsule contains a combined total of at least 600mg of DHA and EPA. Otherwise, additional capsules are necessary.
Whenever a patient eats salmon, herring, sardines, trout or codfish, recommend that they skip one capsule, unless he or she is not getting sufficient DHA and EPA from their brand of supplement.
Taking the supplement with food helps to prevent a fishy aftertaste. For patients who experience this unpleasantness, enteric-coated capsules are available.
Or, patients can take a lecithin capsule with the fish oil capsule. Lecithin is a soy-based product that emulsifies fat.7 It is a very inexpensive capsule and will curtail the fishy aftertaste associated with omega-3 supplements.
Other Natural Supplements
Because our diets are generally rich in omega-6 fatty acid, its supplementation is unnecessary and potentially detrimental. Omega-6 fatty acids can contribute to the development of inflammation. Also, excessive omega-6 intake can actually negate the benefits of omega-3 supplementation.4
Judicious intake of flaxseed oil is permissible because it aids in the production of clearer and thinner meibomian oils, and may thicken the oil layer of tears.5 But, flaxseed oil is not a viable substitute for omega-3 fish oil. This consideration is especially true for elderly patients because their ability to convert the alpha linolenic acid (ALA) found in flaxseed oil to EPA and DHA decreases with advancing age. Also, some individuals lack the ability to convert ALA to EPA and DHA altogether.
Several other supplements may demonstrate anti-inflammatory properties. Both turmeric and ginger are excellent natural anti-inflammatories.7 Turmeric, which is found in curcumin, can be sprinkled on most foods or taken in capsular form. Ginger can be added to vegetable or pasta dishes, be consumed as a tea, or eaten as a candy.
1. Dry Eye Science For Practitioners. Dry Eye Information to Benefit Patient Care. Available at: www.dryeyescience.com (Accessed January 13, 2009).
2. Creuzot C, Passemard M, Viau S, et al. Improvement of dry eye symptoms with polyunsaturated fatty acids. J Fr Ophtalmol 2006 Oct;29(8):868-73.
3. Thornton A. Nutrients restore tear function in dry eye syndrome. Opth Times 2003 May 12;special section.
4. Miljanoviç B, Trivedi KA, Dana MR, et al. Relation between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women. Am J Clin Nutr 2005 Oct;82(4): 887-93.
5. Management and therapy of dry eye disease: report of the Management and Therapy Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 2007 Apr;5(2):163-78.
6. Pratt SG, Ousler GW, Schindelar M, et al. Evaluation of a Novel Dry Eye Oral Supplement for the Treatment of the Signs and Symptoms of Dry Eye in the Controlled Adverse Environment (CAE) Model. Association for Research in Vision and Ophthalmology Meeting (ARVO) 2005. May 1-5, Fort Lauderdale, Fla.
7. Brown NA, Bron AJ, Harding JJ, Dewar HM. Nutrition supplements and the eye. Eye 1998;12 ( Pt 1):127-33.
8. Dry eyes? Eat more fish. Health News 2006 Apr;12(4):11.
9. SanGiovanni JP, Chew EY, Clemons TE, et al. The relationship of dietary lipid intake and age-related macular degeneration in a case-control study: AREDS Report No. 20. Arch Ophthalmol 2007 May;125(5):671-9.
10. SanGiovanni JP, Agrón E, Clemons TE, Chew EY. Omega-3 long-chain polyunsaturated fatty acid intake inversely associated with 12-year progression to advanced age-related macular degeneration. Arch Ophthalmol 2009 Jan;127(1):110-2.
11. Schrader S, Mircheff AK, Geerling G. Animal models of dry eye. Dev Ophthalmol 2008;41:298-312.
12. Butovich IA. On the lipid composition of human meibum and tears: comparative analysis of nonpolar lipids. Invest Ophthalmol Vis Sci 2008 Sep;49(9):3779-89.
13. MP Lange. Personal communication on Nov 25 2008.