Oral omega-6 essential fatty acid treatment in contact lens associated dry eye

Published:February 29, 2008DOI:



      Symptoms of dry eye are commonly reported in contact lens wearers and are a frequent cause of non-tolerance. The purpose of the present study is to evaluate the effects of oral treatment with particular omega-6 fatty acids in the form of evening primrose oil (EPO) on subjective symptoms, ocular surface signs and tear film characteristic in patients with contact lens associated dry eye.


      The study design was randomised, double-masked and placebo controlled. 76 female soft contact lens wearers were treated for 6 months with either EPO or placebo (olive oil). Subjects underwent three examinations (baseline, 3 and 6 months). At each examination subjects were given a questionnaire relating to lens comfort and dry eye symptoms and underwent a series of tests of tear film characteristics (tear meniscus height, break-up time), meibomian gland function (lipid layer thickness and quality) and ocular surface parameters (hyperaemia and staining).


      The EPO group showed a significant improvement in the specific symptom of ‘dryness’ at 3 and 6 months (p < 0.01) and also a significant improvement in overall lens comfort at 6 months (p < 0.01). Tear meniscus height was increased in the EPO group at 6 months relative to baseline (p < 0.01), although all other objective signs were unchanged.


      This study provides evidence for a beneficial effect of particular orally administered omega-6 fatty acids in alleviating dry eye symptoms and improving overall lens comfort in patients suffering from contact lens associated dry eye.


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        • Brennan N.A.
        • Efron N.
        Symptomology of HEMA contact lens wear.
        Optom Vis Sci. 1989; 66: 834-838
        • Begley C.G.
        • Caffery B.
        • Nichols K.K.
        • Chalmers R.
        Responses of contact lens wearers to a dry eye survey.
        Optom Vis Sci. 2000; 77: 40-46
        • Young G.
        • Veys J.
        • Pritchard N.
        • Coleman S.
        A multi-centre study of lapsed contact lens wearers.
        Ophth Physiol Opt. 2002; 22: 516-527
        • Farris R.L.
        The dry eye: its mechanisms and therapy, with evidence that contact lens is a cause.
        CLAO J. 1986; 12: 234-246
        • Lowther G.E.
        Comparison of hydrogel contact lens patients with and without the symptom of dryness.
        Int Contact Lens Clin. 1993; 20: 191-194
        • Thai L.C.
        • Tomlinson A.
        • Doane M.G.
        Effect of contact lens materials on tear physiology.
        Optom Vis Sci. 2004; 81: 194-204
        • Maruyama K.
        • Yokoi N.
        • Takamata A.
        • Kinoshita S.
        Effect of environmental conditions on tear dynamics in soft contact lens wearers.
        Invest Ophthalmol Vis Sci. 2004; 45: 2563-2568
        • Nichols J.J.
        • Mitchell G.L.
        • King-Smith P.E.
        Thinning rate of the precorneal and prelens tear films.
        Invest Ophthalmol Vis Sci. 2005; 46: 2353-2361
        • Nichols J.J.
        • Mitchell G.L.
        • King-Smith P.E.
        The impact of contact lens care solutions on the thickness of the tear film and contact lens.
        Cornea. 2005; 24: 825-832
        • Glasson M.J.
        • Stapleton F.
        • Keay L.
        • Sweeney D.
        • Willcox M.D.
        Differences in clinical parameters and tear film of tolerant and intolerant contact lens wearers.
        Invest Ophthalmol Vis Sci. 2003; 44: 5116-5124
        • Malet F.
        • Karsenti D.
        • Pouliquen P.
        Preservative-free ocular hydrating agents in symptomatic contact lens wearers: saline versus PVP solution.
        Eye Contact Lens. 2003; 29: 38-43
        • Guillon M.
        • Maissa C.
        • Pouliquen P.
        • Delval L.
        Effect of povidone 2% preservative-free eyedrops on contact lens wearers with computer visual syndrome: pilot study.
        Eye Contact Lens. 2004; 30: 34-39
        • Riley C.
        • Chalmers R.L.
        • Pence N.
        The impact of lens choice in the relief of contact lens related symptoms and ocular surface findings.
        Contact Lens Ant Eye. 2005; 28: 9-13
        • Giovagnoli D.
        • Graham S.J.
        Inferior punctal occlusion with removable silicone punctal plugs in the treatment of dry-eye related contact lens discomfort.
        J Am Optom Assoc. 1992; 63: 481-485
        • Virtenal T.
        • Huotari K.
        • Harkonen M.
        • Tervo T.
        Lacrimal plugs as a therapy for contact lens intolerance.
        Eye. 1996; 10: 727-731
        • Stern M.E.
        • Gao J.
        • Siemasko K.F.
        • Beuerman R.W.
        • Pflugfelder S.C.
        The role of the lacrimal functional unit in the pathophysiology of dry eye.
        Exp Eye Res. 2004; 78: 409-416
        • Smith R.E.
        The tear film complex: pathogenesis and emerging therapies for dry eyes.
        Cornea. 2005; 24: 1-7
        • Pflugfelder S.C.
        Antiinflammatory therapy for dry eye.
        Am J Ophthalmol. 2004; 137: 337-342
        • Hom M.M.
        Use of cyclosporine 0.05% ophthalmic emulsion for contact lens intolerant patients.
        Eye Contact Lens. 2006; 32: 109-111
        • James M.J.
        • Gibson R.A.
        • Cleland L.G.
        Dietary polyunsaturated fatty acids and inflammatory mediator production.
        Am J Clin Nutr. 2000; 71: S343-S348
        • Belch J.J.F.
        • Hill A.
        Evening primrose oil and borage oil n rheumatic conditions.
        Am J Clin Nutr. 2000; 71: S352-S356
        • Zurier R.B.
        • Rosetti R.G.
        • Jacobson E.W.
        • DeMarco D.M.
        • Liu N.Y.
        • Temming J.E.
        • et al.
        Gammalinolenic acid treatment of rheumatoid arthritis. A randomized, placebo controlled trial.
        Arthritis Rheum. 1996; 39: 1808-1817
        • Barabino M.
        • Rolando P.
        • Camicione G.
        • Ravera S.
        Systemic linoleic and gamma-linolenic acid therapy in dry eye syndrome with an inflammatory component.
        Cornea. 2003; 22: 97-101
        • Aragona P.
        • Bucolo C.
        • Spinella R.
        • Giuffrida S.
        • Ferreri G.
        Systemic omega-6 essential fatty acid treatment and PGE1 tear content in Sjogren's syndrome patients.
        Invest Ophthalmol Vis Sci. 2005; 46: 4474-4479
        • Terry R.L.
        • Schnider C.M.
        • Holden B.A.
        • Cornish R.
        • Grant T.
        • Sweeney D.
        • et al.
        CCLRU standards for success of daily and extended wear contact lenses.
        Optom Vis Sci. 1993; 70: 234-243
        • van Bijsterveld O.P.
        Diagnostic tests in the Sicca syndrome.
        Arch Ophth. 1969; 82: 10-14
        • Craig J.P.
        • Tomlinson A.
        The importance of the lipid layer in human tear film stability and evaporation.
        Optom Vis Sci. 1997; 74: 8-13
        • Barnes S.A.
        • Lindborg S.R.
        • Seaman Jr., J.W.
        Multiple imputation techniques in small sample clinical trials.
        Stat Med. 2006; 25: 233-245
        • Thakur A.
        • Willcox M.D.
        Contact lens wear alters the production of certain inflammatory mediators in tears.
        Exp Eye Res. 2000; 70: 255-259
        • Pisella P.J.
        • Malet F.
        • Lejeune S.
        • Brignole F.
        • Debbasch C.
        • Bara J.
        • et al.
        Ocular surface changes induced by contact lens wear.
        Cornea. 2001; 20: 820-825
        • Tsubota K.
        • Fujihara T.
        • Saito K.
        • Takeuchi T.
        Conjunctival epithelium expression of HLA-DR in dry eye patients.
        Ophthalmologica. 1999; 213: 16-19
        • Brignole F.
        • Pisella P.J.
        • Goldschild M.
        • De Saint Jean M.
        • Goguel A.
        • Baudouin C.
        Flow cytometric analysis of inflammatory markers in conjunctival epithelial cells of patients with dry eyes.
        Invest Ophthalmol Vis Sci. 2000; 41: 1356-1363
        • Rolando M.
        • Barabino S.
        • Mingari C.
        • Moretti S.
        • Giuffrida S.
        • Calabria G.
        Distribution of conjunctival HLA-DR expression and the pathogenesis of damage in early dry eyes.
        Cornea. 2005; 24: 951-954
        • Albietz J.M.
        Conjunctival histologic findings of dry eye and non-dry eye contact lens wearing subjects.
        CLAO J. 2001; 27: 35-40
        • Macri A.
        • Giuffrida S.
        • Amico V.
        • Iester M.
        • Traverso C.E.
        Effect of linoleic acid and gamma-linolenic acid on tear production, tear clearance and on the ocular surface after photorefractive keratectomy.
        Greafes Arch Clin Exp Ophthalmol. 2003; 241: 561-566
        • Vassilopoulos D.
        • Zurier R.B.
        • Rossetti R.G.
        • Tsokos G.C.
        Gammalinolenic acid and dihomogammalinolenic acid suppress the CD3-mediated signal transduction pathway in human T cells.
        Clin Immunol Immunopathol. 1997; 83: 237-244
        • Hoyng P.F.
        • Verbey N.
        • Thong L.
        • van Haeringen N.J.
        Topical prostaglandins inhibit trauma induced inflammation in the rabbit eye.
        Invest Ophthalmol Vis Sci. 1986; 27: 217-225
        • Pholpramool C.
        Secretory effect of prostaglandins on the rabbit lacrimal gland in vivo.
        Prostaglandins Med. 1979; 3: 185-192
        • Oxholm P.
        • Mathorpe R.
        • Prause J.U.
        • Horrobin D.
        Patients with primary Sjögrens syndrome treated for two months with evening primrose oil.
        Scand J Reumatol. 1996; 15: 103-108
        • Beauchamp G.K.
        • Keast R.S.
        • Morel D.
        • Lin J.
        • Pika J.
        • Han Q.
        • et al.
        Phytochemistry: ibuprofen-like activity in extra-virgin olive oil.
        Nature. 2005; 437: 45-46
        • Simopoulos A.P.
        Essential fatty acids in health and chronic disease.
        Am J Clin Nutr. 1999; 70: S560-S569
        • Miljanovic B.
        • Trivedi K.A.
        • Dana M.R.
        • Gilbard J.P.
        • Buring J.E.
        • Schaumberg D.A.
        Relation between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women.
        Am J Clin Nutr. 2005; 82: 887-893