A randomized controlled trial of omega-3 fatty acids in dry eye syndrome

AIM:To evaluate the role of dietary supplementation of omega-3 fatty acids in dry eye syndrome.METHODS:A prospective,interventional,placebo controlled,double blind randomized trial was done at two referral eye centers.Two hundred and sixty-four eyes of patients with dry eye were randomized to receive one capsule(500mg)two times a day containing 325mg EPA and 175mg DHA for 3 months(omega-3 group).The omega-3 group was compared to a group of patients(n=254)who received a placebo(placebo group).There were 4 patient visits(at baseline,1 month,2 months and3 months).On each visit,recording of corrected distance visual acuity(CDVA),slit lamp examination and questionnaire based symptom evaluation and scoring was done.A symptomatic score of 0-6 was mild,6.1-12moderate and 12.1-18 severe dry eye.Response to intervention was monitored by routine tear function tests like Schirmer I test,tear film break-up time(TBUT),Rose Bengal staining and most notably,conjunctival impression cytology.RESULTS:Sixty-five percent of patients in the omega-3group and 33%of patients in placebo group had significant improvement in symptoms at 3 months(P=0.005).There was a significant change in both Schirmer’s test value and TBUT values in the omega-3group(P【0.001),both comparisons.However,there was a larger drift in TBUT values in omega-3 than the placebo group,in comparison to Schirmer’s test values.The mean TBUT score was 2.54±2.34 in the omega-3group and 0.13±0.16 in placebo group,respectively.The mean reduction in symptom score in omega-3 group was 2.02±0.96 as compared to 0.48±0.22 in placebogroup(P【0.001).Despite a slight increase mean score,the Schirmer scores did not correlate well with symptomatic improvement.CONCLUSION:Omega-3 fatty acids have a definite role for dry eye syndrome.The benefit seems to be more marked in conditions such as blepharitis and meibomian gland disease.The role of omega fatty acids in tear production and secretion needs further evaluation.

Corneal sensitivity,ocular surface health and tear film stability after punctal plug therapy of aqueous deficient dry eye

AIM： To evaluate the effect of punctal occlusion using thermosensitive（smart plug） versus silicone plug for management of aqueous deficient dry eye on cornea sensitivity, ocular surface health and tear film stability.METHODS： A comparative prospective interventiona case study included 45 patients with bilateral severe form of aqueous deficient dry eye. In each patient, the smar plug was inserted in the lower punctum of the right eye which was considered as study group 1 and silicone plug was inserted in the lower punctum of the left eye o the same patient which was considered as study group2. All patients were subjected to careful history taking and questionnaire for subjective assessment of severity of symptoms. Corneal sensitivity, corneal fluorescein rose bengal staining, Schirmer＇s I test, tear film break up time and conjunctival impression cytology were performed pre and 1, 3 and 6mo post plug insertion.RESULTS： A statistically significant improvement in subjective and objective manifestations occurred following treatment with both types of plugs（P 〈0.01）The thermosensitive plug caused significant overal improvement, decrease in frequency of application o tear substitutes and improvement of conjunctiva impression cytology parameters in the inserted side（P 〈0.01）. Canaliculitis was reported in two eyes（4.4% following punctal occlusion using thermosensitive plug（study group 1）. Spontaneous plug loss occurred in 21eyes（46.6%） in the silicone plug group（study group 2）.CONCLUSION： Improvement of subjective and objective manifestations of aqueous deficient dry eye occurs following punctal plug occlusion. Thermosensitive plug has good patient＇s compliance with fewer complications and lower rates of loss compared to the silicone plug.

Clinical efficacy of 0.1% pranoprofen in treatment of dry eye patients：a multicenter, randomized, controlled clinical trial

Background Dry eye is a multifactorial disease of the tears and the ocular surface.This study aimed to investigate the clinical efficacy of a non-steroidal anti-inflammatory drug,pranoprofen,in the treatment of dry eye.Methods It is a prospective,multi-center,randomized,controlled,parallel group study.One hundred and fifteen patients with mild to moderate dry eye disease （55-60 in each treatment group） participated in this multi-center study.Patients were randomly administered with eyedrops containing 0.1％ pranoprofen （PRA） plus 0.1％ sodium hyaluronate （SH） or SH only,three times daily for 28 days,followed by a 1-week after treatment observation.Dry eye symptom score （DESS）,fluorescein corneal staining （FLCS）,tear break-up time （TBUT）,and Shirmer 1 tear test （ST1,without anesthesia） were evaluated or conducted before treatment and at each study visit.Conjunctival impression cytology was taken from the patients treated with PRA plus SH before and after treatment and real-time polymerase chain reaction （RT-PCR） was performed to detect the changes of human leukocyte antigen DR （HLA-DR） and intercellular adhesion molecule 1 （ICAM-1）.Results Patients treated with PRA plus SH showed gradual improvements of DESS,FLCS,and TBUT.Between-group comparisons of FLCS and TBUT have statistically significant differences from day 14.Good tolerance with no severe adverse events was found in both groups.Patients treated with PRA plus SH had a reduced expression level of HLA-DR and were statistically different after 28 days of therapy.Conclusions The application of PRA at a dose of 0.1％ was well tolerated and benefited to the patients with mild to moderate dry eye disease.The underlying mechanism of its efficacy may be associated with the reduction of inflammatory factors of conjunctival epithelial cells.