More benefits of Omega-3 essential fatty acids

As discussed in the previous blog, it is believed that Omega-3 essential fatty acids help with dry eye symptoms. I personally have witnessed this with some of my dry eye patients and believe it to be true in certain cases. So the question many people ask - do I take them or not?

A recent article in the Journal of the American College of Cardiology lists some of the documented benefits of Omega-3's. Among them are decreased triglycerides, lower resting heart rate and lowered blood pressure. A prospective study showed that the benefits are most consistent for Coronary Heart Disease Mortality and Sudden Cardiac Death.

I recommend to most of my patients that they take Omega-3 supplements. Nearly everyone will benefit from them. Those that should use caution are people with diabetes and anyone taking blood thinners or those with bleeding problems. As with all supplements consult your physician before beginning to take them. My book has an extensive discussion regarding Omega-3's.

Omega-3 Essential Fatty acids and Dry Eye

Over the last couple of years there has been much discussion, as well as some disagreement, about the role of Omega-3 intake and dry eye. It is currently believed by most dry eye experts that a full days supply of Omega-3's can increase tear production and decrease dry eye. In my book I discuss this at length as well as the amount and types of Omega-3's to take.

In a recent issue of  Cornea: The Journal of Cornea and External Disease a study was presented that investigated this. The result of the study by Wojtowicz JC, Butovich I, et al. showed that after a 90 day trial, 70% of dry eye patients taking oral Omega-3 supplements had improvement in their dry eye symptoms. They also showed an increased tear volume in their eyes as measured by several clinical tests.

As with all supplements you should consult your physician before taking them, however Omega-3's are believed to help with dry eye as well as having many other health benefits.

Protect your dry eyes from the elements outdoors

My wife and I just returned from a nearly two week medical mission trip to Guatemala. What a rewarding experience!! Our trip was to an area called Huehuetenango, a very rural and impoverished area in the northwestern part of the country. The medical missions that go to the area are the only real eye care that they receive. They welcomed us with graciousness and warmth and I feel very blessed to have been a small part of the lives of so many of these humble people. We saw over 300 patients and treated a wide variety of eye conditions.

This experience also drives home the importance of proper eye protection to prevent and treat dry eye. So many of the people in this area have had long term exposure to wind, dust, and smoke. Their eyes will forever be red, burning, and irritated.

If you have dry eye it is very important to wear proper eye wear when outdoors to protect against excessive tear evaporation. Good coverage sunglasses go a long way towards helping dry eyes feel better. There are some specialized dry eye glasses available which can be read about in my eBook. Regular use of eye protection will make your eyes feel better now and prevent other conditions which will make your eyes feel worse.

Dry eye testing and SPK

In office testing by a qualified Optometrist or Ophthalmologist is critical to diagnosing your dry eye condition. Several tests are performed to rule out other eye related problems as well as quantify the level of dry eye present. One of the most common tests is to apply a dye, called flourescein, to the tears to evaluate the quality of tears and health of he cornea. Flourescein dye marks areas of the cornea that have been damaged due to the dryness. These areas are called Superficial Punctate Keratitis (SPK) and usually appear as small dots made visible from the dye so they appear yellow/green. The location on the cornea as well as the quantity of SPK help the doctor to determine the likely cause and severity of your dry eye. Armed with this knowledge your doctor can prescribe the type of treatment best suited for you.

In this image notice the small and medium sized green spots on the surface of the cornea. In this example they are located randomly over the entire surface.

The presence of SPK indicates that you likely have more than just a mild case of dry eye. T'here are nearly 50 dry eye treatments discussed in the ebook available at dryeyeknowledge.com. You will likely need to have multiple types of treatment to control your dry eye.

More on Meibomian Gland Dysfunction

The importance of the meibomian glands in dry eye has only been recognized in the last few years. A group of worldwide dry eye experts spent over two years evaluating the meibomian glands (see the next blog posting for more information) and their role in the health and disease of the eye. The results of the International Workshop on Meibomian Gland Dysfunction were released earlier this year. They concluded that Meibomian Gland Disease (MGD) is an extremely important condition and very likely the most frequent cause of dry eye disease.

The workshop has helped to advance our understanding of the causes of dry eye and the best types of treatment. If you suffer from dry, irritated eyes it is critical to see a qualified eye doctor to determine if you have this condition. Artificial tears and other traditional dry eye treatment do not address the meibomian glands. If MGD is the cause of your dry eye, they will not provide the relief you seek and your condition will likely continue to worsen with time.

Meibomian Gland Dysfunction (MGD) and dry eye

The normal tear film has three layers made in several places on and around the eye. The top layer is an oily substance produced in the Meibomian glands that sit near the base of the eyelashes. There are approximately 15 glands on each upper and lower lid. This oily layer maintains a stable tear film and reduces evaporation of the tears. Research over the last couple of years has pointed to poor oily layer production as a leading cause or contributor to dry eye.

The normal secretion should be a clear free flowing substance that looks like oil (of course)! Meibomian Gland Dysfunction occurs when this oily secretion is in some way decreased. Some people have only slightly altered production which appears as small particles within the mostly clear fluid. Others have significantly decreased production which appear more like butter or Crisco than oil. The image below shows a thick white secretion from one of the lower meibomian glands.

This gland is plugged and cannot secrete the normal oil. Treatment for this condition is targeted at improving the quality of gland production, ideally restoring it to the original oily state. Many treatments target this condition and are discussed in my book. 

If you have dry eye it is important to see your eye care professional to determine if this condition exists.

Typical Dry Eye Patient

So what is a typical dry eye patient like? Most patients say their eyes feel tired, scratchy, irritated or tired. Most do not say they feel dry. The tear film serves as a protective layer for the cornea. An irregular tear film allows the cornea to be exposed causing these various symptoms.

Some say their vision is poor or fluctuates throughout the day. These fluctuations are directly related to dry eye. The tear layer on the eye is the front focusing (refracting) surface, if it is irregular or incomplete it will impact vision.

The following is a picture of an eye with a very irregular tear film:

This is a view from the microscope (called a slit lamp) of a patient with dry eye. The yellowish appearance comes from flourescein dye doctors put in the eye to visualize the tear film. Notice that the lower half is not a smooth color. It has dark spots and lines which are areas where the tears are breaking apart.

After blinking a normal eye should be smoothly and uniformly covered with tears for about ten seconds. With a dye in the eye it would appear as a smooth yellow tear layer. This is a dry eye patient about 2-3 seconds after they blink. Almost immediately the protective tear layer is breaking apart, exposing the corneal surface and degrading the quality of vision. This test performed by your eye doctor is called a Tear Break Up Time, or TBUT test. A normal score is 10 seconds or more. Less than 10 seconds and you could start having some dry eye problems.

Dry eye treatment is primarily focused on increasing the quality of tears and the amount of time they stay on the cornea. For information on dry eye treatment please visit dryeyeknowledge.com.