There is now growing evidence that the anti-inflammatory properties of omega-3 fatty acids, such as those found in flaxseed oil and fish oil, can relieve dry eye.
According to Jeffrey P. Gilbard, MD, founder and chief executive officer of Advanced Vision Research, and the inventor of the very popular and effective TheraTears (drops and gel) flaxseed oil enriched with fish oil (containing eicosapentaenoic acid [DHA and EPA]) decreases inflammation, stimulates aqueous tear production, and augments the tear film oil layer by enhancing the flow of oil out of the meibomian glands.Flaxseed oil and fish oil are important sources of omega-3 essential fatty acids, one of two types that the body needs but can't produce. The other is omega-6, which is over-abundant in the typical Western diet. Much of that omega-6 is converted to arachidonic acid, which promotes inflammation.
"Americans are eating way too much omega-6 fatty acid while being omega-3 starved," Dr. Gilbard said. By adding an omega-3 supplement into the diet, this balance is reversed. Adding vitamin E to the formulation, or taking it separately, prevents oxidation of the fish and flax oils.
"Studies show that about 90% of Americans are deficient in omega-3 fatty acid intake," said Lawrence Minardi, MD, an ophthalmologist in solo practice in Charleston, WV. "The omega-3 oils are really important for the meibomian glands to work properly. Since many of us are deficient in omega-3 oils, those meibomian glands develop a very thick secretion. Consequently, the oily layer of the tear film is deficient, and people who are deficient in omega-3 oils end up with an evaporative tear loss and dry eye syndrome."
Omega-3 fatty acids, found in salmon, tuna, herring, mackerel, and other cold-water fish, also affect dry eye through another mechanism, Dr. Minardi said. "These oils tend to be anti-inflammatory in the diet, and many cases of dry eye syndrome are related to inflammation of the lacrimal gland and the conjunctiva," he noted. "If we reduce the inflammation via the competitive inhibitory effect of omega-3 fatty acids on the arachidonic acid cascade, then there's less inflammation in the conjunctiva and in the lacrimal glands so there will be better tear production," Dr. Minardi added.
Dr. Minardi also strongly recommends the reduction of simple carbohydrates in one's diet, such as bread (except for whole-grain breads), pasta, rice, and potatoes, which can adversely affect dry eye.
The health benefits of flaxseed and fish oils have been known for years and have been the subject of renewed interest from physicians who believe it might help patients with dry eye and a host of other medical conditions.
Most recently, a study of 32,470 women participating in the Women's Health Study has found that women with a higher dietary intake of omega-3 fatty acids are at decreased risk of developing dry eye. The study, performed by a team of investigators from Harvard Medical School, was to be presented at the Association for Research in Vision and Ophthalmology annual meeting May 4-9 in Fort Lauderdale, FL.
Dr. Minardi said that he has treated more than 300 patients with omega-3 fatty acid supplements in the last several years. "The overwhelming majority have seen significant improvement in their ocular symptoms and dry eyes," he said. "I have dry eye syndrome myself, and I've been taking it for 2 years. My dry eyes are immensely better."
Dr. Minardi also suggests that patients take omega-3 fatty acid supplements before he performs LASIK, since most are omega-3 deficient. He recommends that they continue to use supplements afterward to avoid complications with dry eye that could negatively affect the results of the surgery. He also recommends the supplements to patients who wear contact lenses.
Some opthalmologists now use omega-3 nutrition routinely for patients following LASIK and on patients who have signs of meibomian gland clogging. They have markedly increased tear stability, and in addition they achieve significant increases in visual acuity. Patients who have ocular surface disease following LASIK will complain of visual fluctuation because their cornea breaks down. With the omega-3 supplements they notice that their tear film is a lot more stable and they are able to see better, feel better, have less dryness, and have better visual acuity.The nutritional supplement should be used with artificial tears, preferably TheraTears, at least during the early phase of treatment, Dr. Gilbard said, since the supplement takes effect gradually over about 2 months.
"The way to get rid of dry eye as soon as possible is to treat it from the inside as well as the outside," Dr. Gilbard said. "With the combination, patients get better faster, and some patients are able to stop their eyedrops."
With all the evidence now pointing to the widespread contamination of fish, and the advice now being given that fish be consumed no more than once or twice a week, it is considered advisable to obtain omega-3 from a combination of fish and flax oils.
