As mentioned on the NHS website, dry eye syndrome is a “common condition that occurs when the eyes do not make enough tears or the tears evaporate too quickly”. In turn this leads to the eyes drying out and with it the onset of inflammation (swollen, irritant and red eyes). It is estimated that around 1 in 3 people over the age of 65 suffer from dry eyes, and it is more common in women than men.
Dry eye syndrome, in the vast majority of circumstances, would not be considered a serious condition. However, the symptoms have the ability to cause profound discomfort on a day-to-day basis, and tasks that would normally be mundane and simple become more difficult due to the pain and inflammation.
Our article this week is provided by Iain Johnson, a qualified personal trainer, nutritionist and optician. He looks at dry eye syndrome in more depth and discusses the importance of the ratio between omega 3 and omega 6 in your body to reduce the symptoms of the condition.
One of the biggest complaints that we get in optometric practice is dry eye syndrome (DES). It is far more common in the elderly, especially those who wear contact lenses. Although the term ‘dry eye’ doesn’t sound too debilitating it can cause profound discomfort and as the tears film is the first refractive surface of the eye, it can reduce visual acuity. Working on a computer frequently increases the incidence, and so do chronic conditions such as diabetes.
In 2007 a questionnaire was sent to 690 people to assess the incidence of DES and the impact that it had on peoples day-to-day lives. The results showed that there was an adverse impact on professional work, VDU use, driving (day and night), and even mundane tasks such as watching television. It is certainly not something to be ignored.
The most common treatment for dry eye syndrome is the use of lubricating eye drops. Whilst they can be effective at relieving the symptoms, they fail to fully address the underlying cause. Not only that, but having to use drops frequently is inconvenient and potentially expensive. Fortunately we have other options that can relieve the DES and improve other aspects of health at the same time.
What Causes Dry Eye Syndrome
It was initially thought that DES was caused simply by a lack of aqueous tear production. It is now understood to be a multifactorial condition that involves all of the layers of the tears film and also inflammation of the ocular surface. This is important because it shows that it’s not a simple case of fixing the tear production by slowing the drainage down or using drops to artificially lubricate the eyes. Instead we need to look at options to improve the quality of the tears produced and alleviate the ocular inflammation. Perhaps drops should be seen as a temporary fix whilst the root cause is addressed.
Addressing Inflammation – Omega 3 and Omega 6
Omega 3 and Omega 6 produce signalling molecules known as eicosanoids which control many bodily systems such as the inflammatory response. Generally speaking the omega 3 fatty acid derived eicosanoids are anti-inflammatory and the omega 6 eicosanoids are pro-inflammatory – although it must be stressed that it is an extremely complex pathway that isn’t fully understood. As an example, one study conducted using the omega 6 rich evening primrose oil showed a marked decrease in dry eye symptoms over a six month period compared to a placebo. Evening primrose oil is thought to be one of the only omega 6’s that have an anti-inflammatory effect.
One consideration that is being researched heavily is the ratio between omega 3 and omega 6 in the diet. It is thought that humans evolved on a ratio of around 1/1, and the current ratio is around 16/1 (omega 3/omega 6) in the west. Researchers have already acknowledged that it isn’t simply a case of increasing the amount of omega 3 and omega 6 polyunsaturated fats in the diet, but instead addressing the balance between the two for an overall anti-inflammatory effect that can reduce the chances of DES and other chronic illness.
Addressing the Balance
Some of the best sources of Omega 6 – Vegetable Oil, Margarine, Processed foods, Mayonnaise
Some of the best sources of Omega 3 – Fatty fish, Walnuts, Flaxseeds
As you can see, it’s easy to get plenty of omega 6 with the modern western diet and much harder to obtain sufficient quantities of omega 3. If we look at the fatty acid distribution of common cooking oils the picture becomes even more clear:
Due to the instability of omega 3 polyunsaturated oils they are not often used for high temperature cooking. Increasing the amount of omega 3 in the diet and through supplementation, whilst reducing the amount of omega 6 by using cooking oils that are highest in mono-unsaturated fats like olive oil should be the goal.
DES Omega 3 Studies
There have been numerous studies looking at the relationship between polyunsaturated fats and DES with almost universally positive outcomes. A randomized, double-masked, placebo-controlled trial conducted with 36 patients was conducted in 2011, examining the use of an omega 3 supplement for treating dry eye syndrome. The supplement contained 450mg EPA, 300mg DHA and 1000mg of flaxseed oil. Patients were examined on day 1 and then on day 90. A massive 70% of the patients in the treatment group became asymptomatic at the end of the trial compared to just 7% of the placebo group – a huge success.
It’s hard to argue with the results of this trial. Perhaps the best way is to quote the conclusion of a meta analysis of 7 studies from 2007 to 2013 looking at the efficacy of omega 3 supplementation for DES:
“Our findings suggest that omega 3 fatty acid offers an effective therapy for dry eye syndrome.”
Many supplement companies are making blends that contain essential fatty acids along with antioxidants. Whilst the article has shown that omega 3 fatty acids are an effective treatment for DES, antioxidants are also thought to have some positive effect.
With DES being much more prevalent in the older population, and with people living longer, it is more important than ever to address DES. The condition has negative effects on many areas of day-to-day life and is becoming more common with increased computer use. Taking simple steps to address the issue by increasing the amount of omega 3 in the diet from food and supplementation whilst also decreasing the amount of pro-inflammatory omega 6 can go a long way. Dietary antioxidants can complement this, with many supplements already available that combine the two. Not only will you be reducing dry eye syndrome but also decreasing the chances of some chronic diseases that have an inflammatory component at the same time – a win-win.
Iain Johnson is a dispensing optician with qualifications in nutrition and personal training. He has written for major publications, featured in training DVD’s and regularly lectures on the subject of nutrition and eye health. He is available for consultations, writing and lecturing at www.iainjohnson.com
With many thanks to Iain for this informative article. If you have any questions regarding the health topics raised, please do email me at firstname.lastname@example.org, alternatively please call 01684 310099.
Omega 3 Supplements
Krill Oil – Krill are the most bioeffective natural sources of beneficial Omega 3 fatty acids EPA/ DHA; Astaxanthin, a powerful antioxidant and Choline, an essential neurotransmitter. Krill Oil nutrients can help manage cholesterol and provide powerful antioxidant and anti-inflammatory properties.
Omega 3 Vegan – Vegan Omega 3 from Marine Algae – An ideal vegan source of the important Omega 3 essential fatty acids EPA and DHA. Two gluten-free capsules will provide 334.0mg DHA and 166mg EPA (on average).
- The Vision Care Institute (2008) New Ways to Get to Grips with Dry Eye, [online] Available at: http://www.thevisioncareinstitute.co.uk/dry-eye-course [Accessed 1st Oct 2014].
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