Can omega 3 (fatty acids) help with dry eye syndrome?

Omega-3 Fatty Acids for Dry Eye Syndrome

Omega-3 fatty acid supplements are NOT recommended for moderate to severe dry eye disease based on the highest quality evidence, but may provide modest benefit as adjunctive therapy specifically for meibomian gland dysfunction (MGD)-related dry eye and blepharitis. 1

Evidence Quality and Contradictory Findings

The evidence presents a clear contradiction between older, smaller studies and the most recent, highest-quality trial:

• The definitive DREAM trial (2018), a large-scale, multicenter, double-blind RCT with 535 patients, found no significant benefit of 3000mg daily omega-3 supplementation over 12 months compared to placebo for moderate to severe dry eye. 2 This study showed no improvement in symptoms (OSDI scores), conjunctival staining, corneal staining, tear break-up time, or Schirmer test results. 2

• The 2024 American Academy of Ophthalmology Dry Eye Preferred Practice Pattern explicitly states that a large-scale, masked, prospective study found no benefit of oral fatty acids over 12 months compared with placebo in moderate to severe dry eye patients. 1

• However, the same guideline notes that omega-3 supplements may show some improvement in patients with blepharitis when used as adjunctive therapy. 1

When Omega-3 May Be Considered

For MGD-related dry eye specifically, the American Academy of Ophthalmology recommends omega-3 supplementation as part of Step 1 management, though benefits are modest at best. 3 This should be:

• Combined with lid hygiene and warm compresses, not used as monotherapy 3
• Part of comprehensive MGD management, including dietary modifications with Mediterranean-diet orientation 3
• Used as adjunctive therapy alongside conventional treatments 3

Clinical Algorithm

1. Do NOT recommend omega-3 supplements for patients with moderate to severe aqueous-deficient dry eye as primary or standalone therapy 1, 2

2. Consider omega-3 supplements only if:

   • Patient has MGD-related dry eye or blepharitis 1, 3
   • Used alongside lid hygiene, warm compresses, and artificial tears 3
   • Patient understands benefits are modest and not guaranteed 3

3. Counsel patients about the lack of standardization in supplement formulations in the largely unregulated industry, which affects reliability 1

Important Caveats

• Prostate cancer risk: The association between long-chain omega-3 supplements and prostate cancer remains unclear, though two meta-analyses found no evidence of increased risk. 1

• Computer vision syndrome context: For dry eye related to computer use, pooled data from 2 studies provided low certainty evidence for reduced symptoms with omega-3 supplements, showing approximately 20% symptom reduction. 1 However, this should not override the high-quality DREAM trial findings for general dry eye disease.

• Geographic variation: Some meta-regression analyses suggest higher improvement in studies conducted in India, potentially reflecting baseline dietary omega-3 deficiency in those populations. 4 This may not generalize to Western populations with adequate dietary omega-3 intake.

Practical Implementation

If you choose to recommend omega-3 supplements for MGD/blepharitis patients despite limited evidence:

• Dosing: Studies used 3000mg daily (EPA + DHA combined) 2
• Duration: Assess response at 3 months 5, 6
• Monitoring: Check omega-3 index if available, as patients with low baseline omega-3 index (<4%) may benefit more 5
• Set realistic expectations: Inform patients that the highest quality evidence shows no benefit for general dry eye, and any benefit for MGD is modest 1, 3, 2