Fish Oil Supplements and Dry Eye

When artificial tears fail to treat my patients with dry eye, there are a number of alternatives available (click on Patient Guides and Dry Eye to see them all!)  Omega 3 supplements (fish oil) are a great possibility for using a nutritional additive to increase tear film production.  Many of my patients being monitored for blood pressure issues are already taking fish oil supplements, but new information is casting doubts on the use of fish oil for heart health.  Fish oil still definitely has its place in the ocular medicine world.  Here is an overview of what we know now.

Fish Oil and the Heart

Early research had reported as much as a 29% reduction in death rates from heart attacks when a patient's diet was enriched with foods high in omega 3 fatty acids as far back as 1989.  These early reports had encouraged doctors to recommend fish oil supplements for cardiac health, but a 20 year review of studies is now showing that the risk/reward benefits might not be as large as the original research suggested.  In fact, the newly published 20 year review published in the Journal of the American Medical Association shows no statistical significance in heart attack reduction between omega 3 users and non-users.  This research is still in its infancy, so please talk to your primary care physician about more information.  

Fish Oil and Dry Eye Syndrome

Even if omega 3 supplementation loses its large role in systemic health care, it still provides a great option for treating dry eye.  Omega 3s have a well-documented anti-inflammatory effect, and inflammation at the Meibomian Gland orifice is a large source of dryness.  The Meibomian Glands line the eyelids top and bottom, and every time you blink, the glands secrete a layer of tear film across the surface of the eye.  Inflamed glands result in clogging and a filmy or irregular tear film.  If your tear film is not being secreted onto the eye or is being secreted as thick, greasy tears, your eyes are going to feel a multitude of classic dry eye symptoms: burning, foreign body sensation, tearing, grittiness, blurry vision.  These are all signs of dryness.

The meibomian glands can become clogged (they look like white or yellow caps in the above photo) and
thus prevent tear film from passing through every time you blink.  Photo via westsideoptometrynow.com

Studies have shown remarkable results.  In one study, published in Cornea, patients taking 450 mg of eicosapentaenoic acid (EPA), 300 mg of docosahexaenoic acid (DHA), and 1000 mg of flax seed oil  (all of which contain variants of omega 3s) were found to have improvement in tear production and subjective comfort in 70% of the study participants.  Another group receiving placebo treatment only had a 7% improvement in symptoms.  Wojtowicz JC, Butovich I, Uchiyama E, et al. Pilot, Prospective, Randomized, Double-masked, Placebo-controlled Clinical Trial of an Omega-3 Supplement for Dry Eye. Cornea. 2010 Oct 28. 

How Much Fish Oil is Enough?

Research is ongoing but it is suggested that a minimum of 1500 mg daily of DHA and EPA are required to improve dry eye signs and symptoms.  The best fish oil supplements have something between 70-80% DHA and EHA.  If you are having side effects like nausea of fishy burp or aftertaste, switching to a more purely derived fish oil formula can help!  I recommend Nordic Naturals as a highly pure derivative without any unpleasant taste for those patients that have tried fish oil but stopped due to side effects.