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Treatment of Keroconjunctivitis Sicca and other surface disorders is generally palliative, with the administration of lubricating drops. Current topical products are formulated to both lubricate the eye and enhance certain characteristics of the tear film. For example, hypotonic solutions reduce osmolarity and mucolytic agents can decrease the symptoms of excess mucin strands. Other additives may help lower tension at the water-oil interfaces and mimic some actions of the mucin network. However these palliative measures are temporary and do not address the underlying causes. For example, reduced osmolarity upon instillation may last only about 10 minutes.
A more effective approach may be to address the biochemical basis of an intact tear film. D.F. Horrobin and colleagues have carried out some preliminary studies of the use supplemental intake of essential fatty acids, vitamin B6, and vitamin C to treat dry eye (1). The rationale for this treatment was based on the biosynthesis of prostaglandin E1 (PGE1), which is necessary for aqueous tear secretion by the lacrimal glands.
In this pilot study, 17 patients were selected based on failure of tear secretion, objectively demonstrated (Schirmer Test), clinical exam, and the chronic need/use of lubricant drops. Patients received 2 X 500 mg capsules of evening Primrose oil (Efamol- 73% linoleic acid and 10% gamma-linolenic acid), 50 mg vitamin B6 (pyridoxine) and 1 g vitamin C three times daily
Ten of the 17 patients showed substantial improvement of both symptoms and Schirmer test in 2-6 weeks. 3 additional patients reported improved symptoms though without demonstrating improved Schirmer. The authors conclude that this treatment approach is effective in many cases. They continue to work on dose optimization and plan further testing.
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