At Issue: Dry eye treatment

At Issue posed the following questions to a panel of experts: Do you recommend the use of omega fatty acids to treat dry eye? Why or why not?

Noel A. Alpins, MD

In combination with artificial tears

Managing dry eye has become an important part of postoperative refractive surgery patient management, as dry eye symptoms are among the most frequent complaints of patients who have undergone excimer laser surgery.

This dry eye phenomenon, which is most prevalent in the weeks immediately after the procedure, is principally due to disruption to the corneal innervation, which results in significant reduction of corneal sensation. This leads to reduction in tear secretion from the suppression of the afferent loop, with a consequent increase in tear osmolarity and tear film instability. Similar pathogenesis applies for dry eye syndrome. Traditional treatments for dry eye range from hot compresses, artificial eye drops, gels and steroids to surgical intervention with punctal occlusion and tarsorrhaphy, depending on the degree of dry eye conditions.


	Noel A. Alpins

The most common treatment for dry eye is the use of artificial tears, which provides only instant and incomplete symptom relief. Use of active supplementary compounds such as the omega fatty acids is a recent option for dry eye treatment. Omegas are essential fatty acids, which are known to be deficient in our daily diets.

Supplementation of omegas works in multiple ways to relieve and treat the symptoms of dry eye. It improves the quality of meibomian gland secretion and stimulates aqueous tear secretion by repairing tear secretion in dysfunctional lacrimal glands and decreasing lacrimal gland apoptosis. Omegas also suppress inflammation in blepharitis and meibomitis, as seen in inflammation of joints in rheumatoid arthritis and rosacea.

Intake of omegas, together with artificial tears, will potentially be a successful dry eye treatment for maximizing effectiveness of the existing system. Further clinical trials are indicated to define the advisability of omegas intake and quantify the recommended dosages for this compound’s more widespread use.

For more information:

Noel A. Alpins, MD, can be reached at 7 Chesterville Road, Cheltenham, Victoria 3192 Australia; +61-3-9584-6122; fax: +61-3-9585-0995; e-mail: alpins@newvisionclinics.com.au.

David R. Hardten, MD


	David R. Hardten

Added to established treatments

I recommend the use of omega fatty acids to treat dry eye. Even though there is little significant research to support their use, anecdotal experience in several patients, along with low toxicity, has led me to continue to recommend their use along with the use of flaxseed. I believe that in addition to the usual regimen of lid hygiene, artificial tears, cyclosporine A and lubricating ointments, these easily available, over-the-counter supplements are helpful to many patients and are well tolerated.

For more information:

David R. Hardten, MD, can be reached at Minnesota Eye Consultants, 710 E. 24th St., Suite 106, Minneapolis, MN 55404, U.S.A.; +612-813-3600; fax: +612-813-3658; e-mail: drhardten@mneye.com.

Thomas F. Neuhann, MD


	Thomas F. Neuhann

As part of comprehensive counseling

I recommend a balanced intake of omega-3 and omega-6 polyunsaturated fatty acids. I do so in the context of comprehensive counseling of dry eye patients, usually when they come as new patients.

The basis of my recommendation is basically the positive effect on meibomian secretion (fluidity) and the enhancing effect on aqueous tear secretion (mediated through PGE 1/cAMP). The enhanced production of anti-inflammatory mediators by eicosapentaenoic acid (one of the omega-3 fatty acids) is certainly also useful in dry eye situations.

For more information:

Thomas F. Neuhann, MD, can be reached at Helene-Weber-Allee 19, Munich 80637, Germany; +49-89-159-4040; fax: +49-89-159-40555; e-mail: prof@neuhann.de.