OMEGA-3 AND omega-6 fatty acids are essential components of many nutritional supplements that can be used to treat dry eye disease (DED). The reason: Research shows that a low systemic level of omega fatty acids places one at risk for DED. In addition, research reveals that modifying one’s diet and supplementation of omega-3 and omega-6 fatty acids could be complementary treatments for DED. (Visit ).

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Here’s a look at eight nutritional supplements your colleagues have had success with in this patient population.

(This article represents the views and opinions of optometrists interviewed. Because of the wealth of research available, OM suggests you conduct your own research regarding nutritional supplements.)


Jeff Anshel, O.D., F.A.A.O., of E Street Eyes, in Encinitas, Calif., says he has seen success with Biotears in his DED patients, as DED can be caused by a systemic essential fatty acid (EFA) deficiency, and the nutritional supplement contains black currant seed oil, which is an excellent source of omega-6 EFAs.

In addition, he points out that Biotears contains 18% gamma-linolenic acid (GLA), which converts to a mucous-specific anti-inflammatory agent, further helping patients to achieve relief.

Also, the product contains the proper balance of omega-3s with omega-6s to enhance the production of prostaglandin-E1, also a mucous-specific anti-inflammatory, Dr, Anshel explains.

“However, aging, smoking, alcohol, viral infections, cardiovascular disease, hormonal fluctuation, sugar consumption and chemical carcinogens can hinder the conversion to a mucous-specific anti-inflammatory agent unless EFA is aided by vitamins A, C, B6 and magnesium, which are also contained in Biotears,” he says.

These nutrients also stimulate goblet cell production in the cornea, as well as lacrimal gland aqueous tear and meibomian gland oil function, Dr. Anshel says.


When Arthur B. Epstein, O.D., F.A.A.O., director of cornea and external disease at Phoenix Eye Care and the Dry Eye Center of Arizona, prescribes this product, he says patients experience significantly reduced DED symptoms, while he observes improvements in meibomian gland function, lipid layer thickness, decreased corneal staining and improved tear stability.

This nutritional supplement contains long-chain omega-3s eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are thought to be the building blocks of normal meibum, research reveals. Meibum, produced by the meibomian glands, serves as a barrier to tear evaporation and supports a stable tear structure, Dr. Epstein says.

Dr. Epstein says that Dry Eye Omega Benefits undergoes a re-esterification process to return the oil to a triglyceride state (rTG). This more natural form is more easily absorbed and is more bioavailable, according to research.

Biosyntrx Biotears Vitamins A, C, D, E, B6, magnesium, black currant seed oil, aloe vera leaf oil, omega-3 EPA, DHA, turmeric, green tea N/A
Covalent Medical Focus Relief Plus Omega-3, EPA, DHA, ALA, omega-6, omega-9 and vitamins A, C, D, E and B6. “A Randomized Controlled Trial of Omega-3 Fatty Acids in Dry Eye Syndrome.”
Focus Laboratories TOZAL Vitamins A, C, D, E, B6, B12, folate, zinc, copper, fish oil, omega-3, EPA, DHA, taurine, lutein, zeaxanthin Age-Related Eye Disease Study 2 (AREDS2)
Guardion Health Sciences Omega Boost DHA Concentrate Fish oil concentrate, DHA, EPA “A Randomized, Double-Masked Study to Evaluate the Effect of Omega-3 Fatty Acids Supplementation in Meibomian Gland Dysfunction”
PRN Physician Recommended Nutriceuticals Dry Eye Omega Benefits EPA, DHA, vitamin D3 “Effect of Oral Re-esterified Omega-3 Nutritional Supplementation on Dry Eyes”
ScienceBased Health HydroEye Gamma linolenic acid (GLA) from black currant seed oil, EPA and DHA from USP-verified fish oil, vitamins A, C and B6 and magnesium *“Long-term Supplementation With n-6 and n-3 PUFAs Improves Moderate-to-Severe Keratoconjunctivitis Sicca: A Randomized Double-Blind Clinical Trial”
EyePromise EZ Tears Vitamins A, D and E, fish oil, omega-3, EPA, DHA, evening primrose oil, turmeric root extract, green tea leaf extract, mixed tocotrienol/tocopherol oil *“The ONIT Study–Ocular Nutrition Impact on Tear Film”
Nordic Naturals ProOmega 2000, ProOmega 3.6.9, and ProEPA with concentrated EPA ProOmega 2000: omega-3 EPA and DHA
ProOmega-3.6.9: omega-3 EPA and DHA, concentrated GLA, omega-6 GLA
ProEPA with Concentrated EPA: omega-3 EPA and DHA, concentrated GLA, omega-6 GLA
“Omega-3 Essential Fatty Acids Therapy for Dry Eye Syndrome: A Meta-Analysis of Randomized Controlled Studies”
The manufacturers listed were asked to provide the brand name of their nutritional supplement(s), active ingredients and one study that demonstrated the benefits of the supplement, or the supplement’s active ingredients.


Mile Brujic, O.D., F.A.A.O., of Premier Vision Group, in Bowling Green, Ohio, recommends EyePromise EZ Tears to his DED patients because he says it contains high-quality EFA along with several other ingredients that provide significant anti-inflammatory activity.

Most notable, is the high concentration of omega-3s. Other nutrients in the formula with anti-inflammatory properties include vitamins A, D and E, as well as tocotrienol, Dr. Brujic says.

EyePromise EZ Tears also contains omega-6s extracted from evening primrose oil, which have an additive effect when combined with omega-3s, Dr. Brujic says

“Omega-6s help prevent certain pathways to formulating pro-inflammatory compounds, providing further anti-inflammatory activity,” Dr. Brujic explains.

“If I don’t see improvement, I ask the patient about compliance — since almost all patients who take this product experience improvement in their DED symptoms,” he says.


Dirk Gray, optometrist and low vision specialist, of Lifetime Eyecare, in McCook, Neb., believes TOZAL works well for the patients who come to his clinic. The supplement has a variety of ingredients, including omega-3 fatty acids and vitamins A and C. These ingredients have been shown to have anti-inflammatory properties that may suppress inflammation, which could contribute to DED, according to research.

Dr. Gray believes that patients who consistently use TOZAL may see improvement in their DED symptoms. For individuals with severe DED who remain symptomatic, he recommends the addition of 1,300mg to 2,000mg of omega-3 fatty acids.


Robert Sparrenberger, O.D., of Northern Virginia Doctors of Optometry, in Reston, Va., says he recommends Focus Relief Plus to his DED patients because it contains omega-3 and omega-6, which have been shown to reduce DED-associated inflammation.

“Performing an initial tear osmolarity test [in my practice] and then a follow-up test showed a decrease in tear osmolarity associated with the anti-inflammatory properties of omega supplements,” he says.

Osmolarity decreased to 308 and below, and the difference in osmolarity between eyes was less than 8, Dr. Sparrenberger explains.

When patients answered a questionnaire after taking Focus Relief Plus, along with other treatments, including lipid-based eye drops several times a day, the average improvement was 50%, Dr. Sparrenberger says.


When prescribing HydroEye in addition to other therapies, such as hydrating compresses (Bruder Healthcare) or lid hygiene (Lid Scrub Plus) or other procedures, such as Blephex, Lipiflow (Johnson and Johnson Vision) and eyelid debridement, in some cases, Paul M. Karpecki, O.D., F.A.A.O., director of Cornea and External Disease at the Kentucky Eye Institute, in Lexington, Ky., says he has seen more than 94% of DED patients’ symptoms improve. Improvement typically occurs within one to three months. Also, Dr. Karpecki maintains more than 95% of these patients on HydroEye for the long term.

GLA (omega-6s) is the key ingredient in HydroEye. In the presence of fish oil (omega-3s) and nutrient co-factors, such as magnesium and vitamins C and B6, GLA is converted to dihomo gamma linolenic acid (DGLA), which is a direct precursor of tear-stimulating, anti-inflammatory prostaglandin-E1, Dr. Karpecki says.

“The product has the right combination of GLA and omega-3s to combat inflammation,” Dr. Karpecki says.

In a severe case of Dr. Karpecki’s, a patient with fairly advanced rosacea had lost about half of her glands and couldn’t tolerate other oral medication treatments for DED. Within six weeks of taking HydroEye, her osmolarity dropped from about 330 to 300 mol/L.


Supplementation with omega-3 fatty acids, especially EPA, shows great potential in restoring function to the lacrimal and meibomian glands, which can cause DED when malfunctioning, explains Ann M. Hoscheit, O.D., F.A.A.O., F.A.A.R.M., of EyeBridge Consulting Associates ODPA, in Cramerton, N.C.

She says she seeks omega-3 fish oil in triglyceride form (vs. ethyl ester) for up to 70% better absorption. For purity and fresh taste, she chooses fish oil manufactured without chemicals or excessive heat. And, Dr. Hoscheit prefers concentrates that improve patient compliance, as they have a reduced serving size. All are found in ProOmega 2000, ProOmega-3.6.9, and ProEPA with concentrated GLA, Dr. Hoscheit says. She starts most DED patients with ProOmega 2000.

“By taking two to three 1,000 mg soft gels a day, 95% of compliant patients experience symptom improvement within six to 12 weeks,” she explains.

When patients do not respond to EPA and DHA alone, she may also supplement them with omega-6 GLA, found in ProOmega-3.6.9 and ProEPA with concentrated GLA.


Because he has evaporative DED, Mitch Ibach, O.D., F.A.A.O., of Vance Thompson Vision, in Sioux Falls, S.D., says he tried Omega Boost DHA Concentrate.

“My goal was to find a pharmacy-grade omega-3 and omega-6 product that resulted in minimal burping and gastrointestinal upset and [had] no bad taste,” he explains. “Omega Boost worked well, so I started to prescribe it to patients with evaporative DED.”

The reason it has an acceptable taste and causes fewer gastrointestinal issues is because it comes in a re-esterfied triglyceride form for easier digestion and better absorption, Dr. Ibach says.

He says Omega Boost relieves DED symptoms because omega-3s act as blockers, or inhibitors, of pro-inflammatory markers.

When used with warm compresses and thermal pulsation treatments, 75% to 80% of Dr. Ibach’s patients experience benefits when taking the supplement.


Given that the products mentioned have been shown to provide symptomatic relief, you may want to consider adding a nutritional supplement to your DED armamentarium. OM