Do Omega-3 (polyunsaturated) fatty acids alleviate dry eye syndrome (keratoconjunctivitis sicca)?

From the Guidelines

Omega-3 fatty acids do not have a significant benefit in treating dry eyes, according to the most recent and highest quality study. The study, published in 2019 1, found that a prospective, multicenter, masked large-scale trial of 3000 mg of omega-3 fatty acids for 12 months did not show any benefit in patient symptoms or signs over placebo. This suggests that omega-3 fatty acids may not be an effective treatment for dry eyes.

Some key points to consider:

• The study found no significant difference in patient symptoms or signs between the omega-3 fatty acid group and the placebo group 1.
• Other treatments, such as topical cyclosporine and lifitegrast, have been shown to be effective in treating dry eyes 1.
• Patients with dry eyes should be evaluated and managed for underlying conditions, such as Sjögren's syndrome, and should be cautioned about the potential for worsened dry eye symptoms after surgery 1.
• Artificial tears and other treatments, such as warm compresses and blinking exercises, may be helpful in managing dry eye symptoms 1.

It's worth noting that while omega-3 fatty acids may not be effective in treating dry eyes, they may have other health benefits. However, based on the current evidence, they should not be relied upon as a primary treatment for dry eyes. Instead, patients should consult with their doctor to determine the best course of treatment for their individual needs.

From the Research

Omega-3 Fatty Acids and Dry Eyes

• Omega-3 fatty acid supplementation has been shown to improve dry eye symptoms and signs in patients with dry eye disease 2, 3, 4.
• A meta-analysis of randomized clinical trials found that omega-3 fatty acid supplementation decreased dry eye symptoms and corneal fluorescein staining, and increased tear break-up time and Schirmer test values 2.
• Another study found that long-chain omega-3 supplementation may be beneficial in managing dry eye disease, although the evidence is uncertain and inconsistent 5.
• Omega-3 fatty acid supplementation has been shown to improve tear break-up time, Schirmer's test, and reduce tear osmolarity in patients with dry eye syndrome 3, 4.

Mechanism of Action

• Omega-3 fatty acids have anti-inflammatory effects, which may help to reduce inflammation in the eyes and improve dry eye symptoms 5, 6.
• The ratio of omega-6 to omega-3 fatty acids in the diet may also play a role in the development and treatment of dry eye disease 6.

Effective Dosage and Treatment Duration

• The effective dosage and treatment duration of omega-3 fatty acid supplementation for dry eye disease are not well established, and more research is needed to determine the optimal dosage and treatment duration 5, 6, 4.
• A study found that supplementation with 180 mg of eicosapentaenoic acid and 120 mg of docosahexaenoic acid per day for 6 months improved dry eye symptoms and signs in symptomatic visual display terminal users 4.

Predictors of Response to Treatment

• The omega-3 index, which measures the ratio of EPA and DHA in red blood cell membranes, may be a predictor of response to omega-3 fatty acid supplementation for dry eye disease 4.
• Patients with a low omega-3 index may be more likely to benefit from omega-3 fatty acid supplementation for dry eye disease 4.