J.D. Aronowicz

Pilot, Prospective, Randomized, Double-masked, Placebo-controlled Clinical Trial of an Omega-3 Supplement for Dry Eye

Purpose: To investigate the potential effect of dietary supplementation with omega-3 fatty acid on lipid composition of meibum, aqueous tear evaporation, and tear volume in patients with dry eye. Methods: In a pilot, prospective, randomized, double-masked study, patients with dry eye received a daily dose of fish oil, containing 450 mg of eicosapentaenoic acid, 300 mg of docosahexaenoic acid, and 1000 mg of flaxseed oil (TheraTears Nutrition; Advanced Vision Research, Woburn, MA) for 90 days. There were 2 patient visits: baseline and final. At these visits, patients completed the ocular surface disease index to score subjective symptoms, and slit-lamp examinations, breakup time, corneal staining, Schirmer type I, fluorophotometry, evaporometry, and collection of meibomian gland secretion samples for lipid composition analysis were performed. Results: A total of 36 patients with dry eye completed the study. At the end of the study, 70% of the patients became asymptomatic, whereas for the placebo group, 7% of the symptomatic patients became asymptomatic. Schirmer testing and fluorophotometry suggested that the omega-3 supplement increased tear secretion. The lipid composition of the samples collected from the omega-3 group was found to be very similar to that from the placebo group. No trends between groups were seen for other objective parameters. Conclusions: Dietary supplementation with omega-3 fatty acids in dry eye showed no significant effect in meibum lipid composition or aqueous tear evaporation rate. On the other hand, the average tear production and tear volume was increased in the omega-3 group as indicated by both Schirmer testing and fluorophotometry.

Increased evaporative rates in laboratory testing conditions simulating airplane cabin relative humidity: an important factor for dry eye syndrome.

Purpose. To quantitatively explore the relationship between low relative humidity conditions, as experienced in airplane cabins during flight, and increases in aqueous tear evaporation as a potential explanation for increased dry eye symptoms noted by people when in low humidity environmental conditions. Methods. Prospective experimental laboratory study. Evaporative rates under two different ranges of increasing relative humidity, from 20% to 25% (similar to the relative humidity in airplane cabins or arid regions) and from 40% to 45% (similar to the relative humidity in nonarid regions), were obtained from 18 patients with dry eye and 11 healthy subjects. Results. Statistically significant differences were found within all groups: patients with dry eye (divided into keratoconjunctivitis sicca [P=0.001] and meibomian gland dysfunction [P=0.007]) and healthy subjects (P≤0.001). The mean increase in evaporative rate across all study subjects was 99.72% (P≤0.001) when the eyes were exposed to the lower humidity condition. Conclusions. These studies quantitatively show the negative impact of environmental low relative humidity conditions, including those associated with commercial airplane travel, on aqueous tear evaporation dynamics. The increased evaporative rate is similar in healthy subjects and patients with dry eye. These findings provide useful data for the development and evaluation of treatment paradigms for any person who notes dry eye symptoms in low relative humidity environments.

Short term oral minocycline treatment of meibomianitis

Aim: To evaluate the clinical impact, aqueous tear parameters, and meibomian gland morphology in patients with primary meibomianitis before, during, and 3 months after a course of oral minocycline. Methods: 16 patients were prospectively enrolled, 11 male and five female (mean age 69 years old). Each patient received routine clinical evaluations before, after 3 months therapy, and at 6 month study follow up visit. The clinical appearance, tear volume, flow and turnover, evaporation, Schirmer I test, meibomian gland dropout, lissamine green staining, and bacteriology wer evaluated. Results: Improvement was observed in clinical signs of meibomianitis at the second and third visits. Microbial culture findings improved. Decreased aqueous tear volume and flow, and increased evaporation rate range at 35–45% relative humidity (RH) (p<0.05) were also detected. Other related tear parameters did not change. Meibomian gland dropout showed no improvement. Conclusions: 3 months of oral minocycline resulted in clinical improvements in all meibomianitis signs that persisted for at least 3 months after discontinuation despite decreased aqueous tear volume and flow with increased evaporation (35–45% RH). However, there was improvement in the turbidity of secretions. Short term minocycline therapy probably has efficacy in the management of meibomianitis that extends beyond eradication of bacteria.

Pattern of vital staining and its correlation with aqueous tear deficiency and meibomian gland dropout.

Purpose. To assess the relationship between the degree and anatomic location of ocular surface vital staining and the degree of aqueous tear deficiency in patients with dry eye, as measured by the Schirmer test, and the presence of meibomian gland dropout. Methods. Twenty-two patients with dry eye (nine men and 13 women; mean age, 60 years) were prospectively enrolled in the study. Eleven subjects with no ocular disease were considered control subjects. Lissamine green vital staining, Schirmer test, and meibomian gland dropout were evaluated. Results. Patients were stratified based on their vital staining pattern (presence or absence of corneal staining). A progressive decrease in the Schirmer test result was found when the vital staining score increased (r = –0.655; P<0.0001). Patients with dry eye showed an increase in meibomian gland dropout when compared to control subjects (P≤0.001). Conclusions. The presence of corneal vital staining correlates with a more severe dry eye as shown by the Schirmer test. Patients with dry eye have an increased meibomian gland dropout. The degree and pattern of vital staining correlate with the severity of dry eye.