The Role of Omega 3 in Dry Eye Management

 How is eating 2 servings of salmon or tuna a week supposed to help support the stability of your tear film? Why would taking a daily fish or algae based omega-3 supplement daily be beneficial in individuals suffering from dry eye? 

To answer these questions, it is helpful to review the role of inflammation in chronic conditions including tear film instability and/or dry eye. Symptoms such as swelling, redness, heat and pain occur when the body has an inflammatory response. The inflammation response is a defense mechanism and helpful in acute situations such as a bacterial infection. However, things that cause our body to produce a long-term inflammatory response leads to excessive damage of nearby healthy tissues. 

Near the eye, this body-wide inflammation leads to dysfunction and destruction of the water producing Lacrimal glands and/or the oil producing Meibomian glands that secrete contents used to coat the surface of the eye. The coating produced by these damaged glands has poor stability and leads to symptoms such as dryness, burning, watering and redness. Inflammation can be complex and caused by many things. However, one known factor in body-wide inflammation is the type and amount of fat present in our diet. Omega-3 fatty acids (specifically EPA & DHA) are strong anti-inflammatory fats that stop the body’s inflammation response. It has been demonstrated that consuming adequate amounts of these healthy fats can be beneficial in symptom relief individuals with inflammatory and/or evaporative dry eye.

When possible, try to get omega-3 fatty acids from foods rather than supplements. When you get your fatty acids via your food, you know it’s in its natural Triglyceride form which we easily digest. In contrast, supplements must go through purification processes that most often result in them being left in an Ester form that is not easily digestible and associated with side effects such as burping and fishy taste. As able, aim to eat 3.5 ounces of non-fried, oily fish, high in DHA and EPA omega-3 fatty acids at least two times a week (preferably with 3 days between servings). Sockeye or pink salmon from Alaska is high in these beneficial omega-3 fatty acids and low in contaminants. Skipjack, Tongol, and/or canned “chunk light” tuna are also great options. Be wary of Albacore, Yellowfin, Bigeye, or canned “solid white” tuna which are high in mercury levels and can not be consumed as often. 

Further daily dietary supplementation can be provided via plant omega 3 sources (ALA) such as avocados and ground flax seed. Unfortunately, the human body does not get the entire amount of listed ALA omega 3 as it has to first convert it to the EPA & DHA forms. During this conversion, much of the omega 3 is lost. This makes it difficult to get the daily recommended levels of omega 3 if only getting via plants in the diet. 

If you are unable to follow the above recommended dietary omega 3 intake recommendations, daily omega 3 supplementation is a great alternative. Taking 1000-3000mg of a fish oil in the Triglyceride form (with a combined EPA/DHA of at least 600mg per 1000mg capsule) is recommended daily for inflammatory conditions. My personal favorite is Nordic Naturals ProOmega. 

Taking supplements that combine omega 3 with other known anti-inflammatory compounds such as Evening Primrose Oil, Black Currant Seed Oil, Borage Seed Oil, Vitamin A, Maqui berry and turmeric have also shown to have success. Due to some of the other added components, they have shown improved signs and symptoms in dry eye patients despite the fact they have lower levels of fish oils than what is recommended when taking fish oil alone. 

Omega 3 supplementation when combined with other at home therapies and in-office treatments can improve their abilities to provide symptom relief. However, Omega 3 supplementation is not right for everyone. Further conversation with your primary care doctor and/or eye care provider can help determine whether any of the above recommendations may benefit you.