30 day supply: 120 capsules
A leading, doctor-recommended dry eye treatment that provides continuous relief from dry eye discomfort due to: age, tear deficiency, contact lens wear, computer use, frequent flying, LASIK surgery, and other causes.
Patented oral formula works from the inside out to target the root causes of dry eye.
Features a proprietary blend of omega fatty acids and nutrient cofactors that help reduce inflammation, an underlying cause of dry eye, and support all three layers of the tear film. View supplement facts
Much more powerful than flaxseed oil or fish oil alone, HydroEye includes omega-3 EPA and DHA from highly pure USP®-verified fish oil and also provides the unique omega fatty acid, GLA, from black currant seed oil that cannot be easily obtained from the diet. GLA has been found to play a key role in dampening dry eye symptoms in five clinical studies. GLA is not found in flaxseed or fish oil. View studies on GLA’s role in dry eye.
HydroEye has been found to raise levels of lactoferrin, a protective protein found in tears. Read about the study.
Offers uninterrupted dry eye relief with continued use; results typically experienced within 30-60 days.
Replaces the need for eye drops for most users.
Made from premium ingredients in NSF®-Certified facilities.
Money-back guarantee. Try HydroEye risk-free for 60 days.
Suggested Use: take a total of four capsules daily, with meals (two capsules taken orally, twice daily).
Note: use with anticoagulants may increase their effect and prolong prothrombin time. Pregnant or lactating women and individuals with known medical conditions should consult a physician before using.
Omega Fatty Acids: GLA (235 mg)
from Black Currant Seed Oil, EPA (100 mg) and DHA (70 mg)
from Fish Oil
GLA, a unique and specialized omega-6 fatty acid from black currant seed oil, is found only in ultra trace amounts in the diet. GLA can be converted to the anti-inflammatory prostaglandin, PGE1, which supports normal tear secretion. Clinical studies report that GLA reduces symptoms and calms inflammation in those with dry eye, improves symptoms and increases tear production in people undergoing corrective laser procedures, and improves contact lens comfort. It also reduces symptoms and increases anti-inflammatory prostaglandin levels in those with Sjögren's syndrome.
Black currant seed oil also contributes
alpha linolenic acid, an important omega-3 fatty acid. A
controlled study in healthy older individuals found that
black currant seed oil decreased production of the pro-inflammatory
prostaglandin, PGE2, and improved immune function compared
to a placebo.
Fish oil is a concentrated source of
the omega-3 fats EPA
Higher dietary intake of EPA
may reduce the risk of dry eye, in addition to providing
well established cardiovascular benefits. Combining fish
from black currant seed oil in balanced amounts helps block
the formation of inflammatory prostaglandins. HydroEye features
highest quality USP-verified fish oil from the purest sources.
Vitamin C (240 mg)
C is the most abundant
water-soluble antioxidant in tear fluid. It acts to neutralize
free radicals and helps recharge the antioxidant vitamin
E. Biomarkers of oxidative damage are higher in the tear
fluid of dry eye patients compared to controls. Levels of
vitamin C are also known to drop significantly in the tears
of people undergoing laser surgery - procedures known to
generate free radical activity. In addition to its free
radical fighting role, Vitamin
C may also stimulate the
formation of less inflammatory prostaglandins from GLA metabolism.
Other Essential Nutrients
HydroEye delivers Vitamin
essential nutrient for the health of the epithelial cells
of the eyes cornea and conjunctiva. Vitamin
A is also
required for the manufacture of mucin, the primary component
of the mucous or innermost layer of the tear film. HydroEye
contributes mucin, which is secreted by goblet and epithelial
cells of the conjunctiva to protect, lubricate and ensure
even distribution of tear fluid. Loss of goblet cells has
been associated with chronic inflammation of the ocular
surface in tear deficient dry eye.
Dietary shortfalls of magnesium
B6 are not uncommon, especially among women
and older individuals (groups in which dry eye commonly
occurs). HydroEye includes these nutrients, which are important
cofactors for the conversion of linoleic acid from black
currant seed oil into GLA. One of the critical catalysts
for this conversion is an enzyme whose activity declines
with nutrient deficiencies, as well as with age, certain
diseases, increased stress hormones and excessive intakes
of saturated fats.
Omega-3s, Zinc & "C" May Ease
Results of new research suggest that a combination
of fish oil, zinc
C can improve the symptoms of bronchial asthma in children
(1). Asthma, which affects nearly
20 million Americans, is on the rise according to the American
In this double-blind study, 60 asthmatic
children were supplemented with 300 mg of EPA
15 mg of zinc,
200 mg of ascorbic acid, a combination of all the nutrients or
a placebo for 6 week periods. Lung function was measured, as were
markers of inflammation. Symptoms such as wheezing, shortness
of breath and the use of rescue inhalers were measured in a standardized
The researchers found significant improvement
in all the tests when the nutrients were given one at a time.
However all three nutrients combined produced the best results.
Omega-3s & Better Blood Pressure in Dieters
One of the many benefits of weight loss is
often blood pressure reduction, and results of a recent study
suggest that the omega-3s can result in even better reductions
- at least in those who have low levels of the omega-3 DHA
stored in their cell membranes (2).
Low levels of cellular omega-3 are believed to reflect infrequent
intake of these important fatty acids.
All of the 324 overweight study participants,
aged 20-40, were put on weight loss diets and divided into 4 different
groups. One group ate salmon 3 times weekly, while another consumed
cod, which is lower in omega-3 content. The third group was given
supplements providing about 495 mg of EPA
daily, while the forth group was assigned to a placebo and ate
All of the study subjects lost weight - a
little over 11 pounds on average. Blood pressure also went down
overall, but reductions were greater in those eating salmon or
receiving the daily omega-3 supplement compared to people in the
cod-consuming group and in placebo-takers who had low stores of
the omega-3 to begin with. These observations are in line with
a number of other study findings that indicate blood pressure
reductions with greater EPA
GLA Makes Contact Wear More Comfortable
Contact lens wearers commonly experience
a feeling of dryness in their eyes. As a result, many people wear
their lenses less often or discontinue their use altogether. A
recent double-blind, placebo-controlled study examined the effects
of 300 mg of supplemental GLA
daily in 76 women with contact lens-related dry eye (3).
The participants all wore soft contact lens.
The women in the GLA
group experienced significant improvement in the sensation of
dryness and overall lens comfort at 3 months and at 6 months,
when the study ended. Tear meniscus height - a relatively new
measurement of tear production - was also greater in the GLA
supplementers compared to placebo.
Antioxidants, Exercise Boost Bones in Women
The results of a pilot study in 34 post-menopausal
women suggest that a combination of antioxidant supplements and
resistance training may help protect against bone loss. The women
were assigned to 1 of 4 groups: 1) antioxidants plus exercise;
2) antioxidants and no exercise; 3) placebo plus exercise; or
4) placebo and no exercise. The antioxidants consisted of 600
E and 1,000 mg of vitamin
At the end of 6 months, measures of bone
density revealed that only those women not exercising and getting
the placebo experienced significant bone loss in the spine. In
contrast, the bone density of those who exercised or took the
antioxidants remained constant. These preliminary findings are
promising and lend support to previous links seen between higher
intake of antioxidants (e.g. lycopene) and better bone density
in the spine of women and, for men, in the hip.
Contact Lens Wear Can Lead to Dry Eye
Most people are aware that dry eye is a pervasive
problem. Estimated to affect up to 1 in 5 adults, it is the most common
condition seen in ophthalmology practices. Lesser known, however, is that dry
eye is also the most common complaint among those who wear contact lenses.
In some cases, people who already have existing, marginal
dry eye can experience worsening of the condition when they begin to wear
contact lenses. For others, the lenses themselves may lead to dry eye symptoms
Disturbing the Tear Film
The tear film that hydrates and lubricates the optical
surface of the eye is composed of several layers. There is an oily outer layer
which helps prevent the tear fluid from evaporating, and an inner layer of fluid
that also contains a mucous-like gel which allows the fluid to spread evenly
over the surface. A normal and stable tear film is necessary in order to be a
successful contact lens wearer who does not suffer from symptoms of dryness or
sensation of grittiness.
When a contact lens is placed in the eye, the lens can
alter the normal structure of the tear film and affect its rate of evaporation.
Greater evaporation leads to increased osmolarity (saltiness or lower volume of
tear fluid) - a good predictor of dry eye (1). Tear
osmolarity is often elevated in contact lens wearers, and even more so in those
who can't tolerate them.
For those who have been wearing their lenses for many
years, there may be another contributing factor. The continual rubbing of the
lens across the surface of the cornea may result in some loss of the microscopic
hair-like structures called microvilli that exist on the outermost layer of the
cornea. The microvilli bind to the mucous-like gel in the tear fluid so that the
tear film adheres well to the cornea and maintains a stable, uniform layer on
It's believed that the constant movement of the contact
lens across the surface of the cornea over years of wear may reduce the
microvilli. In turn, this can destabilize the tear film and result in contact
lens-induced dry eye. It is also thought that discontinuing lens use temporarily
will help restore microvilli.
Strategies for More Successful Lens Wear
Contact lenses are often a good alternative for people
who are bothered by the cosmetic appearance of eyeglasses or the limitation to
activities that they pose. To have a comfortable experience with contact lenses,
it's important to be under the care of an eye care practitioner to ensure that
the lens fit and lens materials you currently have are the best possible choice
The type of lens chosen may make a difference in reducing
the chance for dry eye. While some research has not shown a difference in tear
osmolarity between soft, water-containing lens and the rigid, gas-permeable type
of lens, in some cases soft, high-water content lenses may not be the best
choice (2). In general, the more water a soft
contact lens contains, the more prone it is to become dehydrated. As water
evaporates from the front of the water-containing lens during wear, the lens
draws moisture from the tear film. In addition to choosing appropriate lens
materials, your eye doctor may also recommend lubricating drops or other aids,
and suggest ways to modify environmental factors that can exacerbate dry eye
such as overheated rooms, use of hairdryers or uninterrupted time at the
Important Fatty Acids Can Be Helpful
An additional strategy is to try supplemental
EPA, fatty acids that can bolster one's own natural, inflammation-fighting
ability. Whatever the cause of dry eye - insufficient tear production,
evaporation, chronic allergy or other - the result is an inflammatory reaction,
and the contact lens wearer with symptoms of dryness is no exception
(3). Research suggests that fatty acid supplementation can help calm
inflammation and improve dry eye symptoms (4).
Balanced amounts of
EPA work together to reduce production of pro-inflammatory compounds while
increasing the manufacture of compounds that are anti-inflammatory.
Dry Eye Affects Millions of Americans
If you experience scratchy, red, burning, irritated, even
excessively teary eyes, you may be suffering from dry eye, one of the most frequent
problems seen by eye care practitioners. While the condition is more common
among older women and men, and those with the autoimmune diseases rheumatoid
arthritis or Sjögren's, it can impact healthy people of all ages: particularly
those who wear contact lenses, have ocular surface inflammation from allergies,
undergo LASIK corrective surgery, live in dry climates or spend long hours in
front of the computer screen.
There are a number of practical steps you can take to
reduce your risk of getting dry eye, or to help relieve symptoms if you already
suffer dry eye discomfort.
The Role of Diet and Supplementation
There are now topical drugs available to fight the
inflammation of dry eye, ocular procedures to help retain tears and ointments or
drops that provide temporary relief. However, diet and supplementation can also
make a difference. Supplementation with the fatty acid
gamma-linolenic acid (GLA) has been reported
to reduce symptoms, dampen inflammation and increase tear production in clinical
studies of people with dry eye (1,2). Inflammation is an important factor in dry
eye, and GLA can help the body build its own
anti-inflammatory compounds. It can also support the oily outer layer of the
tear film which helps prevent tear fluid from drying out.
Regular intake of fatty fish such as tuna and salmon has
been linked with a lower risk of developing dry eye in older women
(3). Eating ample amounts of fruits and vegetables is also a good
strategy, as the antioxidants they contain can help fight the free radicals,
which accompany inflammation. Vitamin C from citrus or bell peppers, for
instance, is a key antioxidant in eye tissue.
Avoiding Environmental Triggers
A number of factors can worsen dry eye or even trigger
the condition. If you smoke take steps to stop,
since both smoking and exposure to second hand smoke can be very eye-irritating.
Avoid conditions that promote eye dryness such as very warm or overly
air-conditioned rooms. Using a humidifier to keep the air moist can also be very
Having dry eye can affect the vision we need for daily
activities like driving or reading. But new research from Ohio State University
College of Optometry has shown that long periods at the computer or reading can
also bring on dry eye or worsen its irritating symptoms
Squinting Squelches the Blink Reflex
Squinting, a common practice among computer users or
those trying to bring type into better focus, causes people to blink less often.
Tears naturally evaporate when the eyes are open, and blinking is necessary to
spread new tears produced by the tear glands. The Ohio State investigators
hooked small electrodes to the lower lids of volunteers to measure the activity
a muscle involved in both squinting and blinking.
When the volunteers squinted, they blinked half as often.
They also reported more dryness and tearing. Earlier work by the same team found
that people blinked 22 times per minute when relaxed, 10 times while reading a
book, and 7 times when viewing text on a computer screen. Computer users can
reduce the harmful effects on their eyes, by alleviating glare and the
conditions that cause them to squint more often, according to the study's
Minimizing Risks of Visual Discomfort
The Mayo Clinic offers these solutions to common risk
factors that cause squinting and eye discomfort:
Know someone who's
scheduled for vision-corrective laser surgery? GLA may help!
LASIK or PRK Can Cause
Temporary Dry Eye
Some people, who are appropriate candidates, opt for laser surgery to help
correct their vision. The two most common types of procedures are LASIK (Laser
In Situ Keratomileusis) and PRK (Photorefractive Keratectomy). These popular
procedures use a laser or a combination of microsurgery and laser to reshape the
eye's cornea. Reshaping the cornea alters the focusing power of the eye,
allowing one to become less dependent upon glasses or contact lenses.
Having Dry Eye Before
Surgery May Prolong or Worsen Symptoms Afterward
One common side-effect of the surgery is dry eye. It can make the cornea less
sensitive, resulting in lower tear production and inflammation. The good news is
that dry eye is temporary, typically lasting no more than a month. But symptoms
may last longer and be more severe in people who already have dry eye before
they undergo the surgery (1).
What Is Dry Eye
A common condition, dry eye has many causes. One of the most common reasons is
the normal aging process. It's also associated with certain conditions such as
rosacea and Parkinson's. Women frequently experience dry eye, especially as they
enter menopause. Symptoms include itching, burning, or a gritty sensation - even
tearing when the eye is irritated. Visual efforts like reading or computer time
can aggravate symptoms, and other factors such as hot, dry, or windy climates;
high altitudes; air-conditioning; and cigarette smoke are also contributors.
Ironically, contact lens wear can also contribute to or worsen dry eye, which
often leads people to laser surgery.
Special Fatty Acids May
Italian researchers recently investigated the effects of fatty acids on dry eye
in people undergoing PRK. Thirty patients were given supplements of linoleic
acid and gamma-linolenic acid or
GLA. Another group underwent PRK without the supplement. Compared to the
untreated control patients, the group getting fatty acids were found to have
significantly fewer symptoms of dry as measured by questionnaire. They also
scored better in the Schirmer test-a method for measuring tear production-and
their eyes were able to more readily clear a staining dye from their tears,
reflecting better ocular surface sensitivity and tear clearance.
GLA is a specialized fatty
acid with the ability to modify inflammation and support tear production (2-4).
These researchers concluded that
GLA as a precursor to anti-inflammatory compounds, could be helpful in
increasing tear production and clearance after PRK (5).
HydroEye is a unique, oral formulation for dry eye relief. It provides
GLA and nutrient cofactors that help dampen inflammation and support a
healthy tear film.
GLA & EPA / DHA Blend Reduces Inflammatory Marker in Dry Eye
Dry Eye Syndrome (DES) and Fatty Acids
A wide range of anti-inflammatory therapies have been investigated to reduce DES, including the use of supplements containing the omega-6 fatty acid gamma linolenic acid (GLA), and the omega-3 fatty acids eicosapentaenoic and docosahexaenoic (EPA and DHA).
Supplements providing GLA have been shown to increase the concentration of anti-inflammatory prostaglandin E1 in tears, and to reduce inflammation of the ocular surface as shown by a significant decrease in the inflammatory marker human leukocyte antigen-DR (HLA-DR) in conjunctival epithelial cells. HLA-DR class II antigen is usually expressed by antigen-presenting cells with major histocompatibility complex (MHC) on their surfaces such as dendritic cells and macrophages.
The fatty acids EPA and DHA also have anti-inflammatory action believed to result from the synthesis of prostaglandin E3 and leukotriene B5. Leukotriene B5 inhibits the conversion of arachidonic acid to potentially harmful inflammatory mediators, prostaglandin E2 and leukotriene B4.
Combining GLA and EPA/DHA in DES
The efficacy of combining GLA and EPA/DHA has been reported in an animal model of DES, where only the combined fatty acids (versus GLA or EPA/DHA alone) reduced the expression of MHC II and inhibited the production of inflammatory cytokines (1). In a pilot trial, 3-months of treatment with the fatty acid combination suggested a beneficial effect on the clinical signs of ocular dryness (2).
The objectives of the present controlled trial were to investigate the effect of omega-6 and omega-3 supplementation on HLA-DR inflammatory marker in conjunctival cells, and to determine the impact on signs and symptoms in patients with DES.
138 eligible adult patients with mild to moderate DES were randomized to receive placebo or treatment supplement containing omega-3 and omega-6 fatty acids, vitamins and zinc 3 times daily for 3 months. Impression cytology was performed at baseline and 3 months to assess the percentage of cells expressing
HLA-DR and to evaluate fluorescence intensity, an alternate measure of HLA-DR. Signs of dry eye (Schirmer, TBUT, fluorescein and lissamine staining) were evaluated; Symptoms were evaluated via a quality of life questionnaire. Statistical analyses were performed on the full analysis set, and on those patients who completed the trial (per-protocol set or PPS).
Of the patients randomized, 121 with available impression cytology were included in the full analysis set. Of those 121 patients, 106 with no major protocol deviations comprised the PPS.
In the PPS, there was a significant reduction the % of HLA-DR positive cells in the fatty acids group compared to placebo (p = 0.021). Expression of HLA-DR as measured by fluorescence intensity was also reduced in the fatty acids group of the full analysis set (p = 0.041) and in the PPS compared to placebo (p = 0.017). No significant difference between groups was found in signs and symptoms, though there was a tendency toward improvement in the fatty acids group.
The authors conclude that this supplemental fatty acid combination can reduce expression of conjunctival inflammatory markers.
A discrepancy between signs and symptoms and a biological marker is very common in ocular surface disease, and highlights the need for objective endpoints like inflammatory marker assessment for an earlier and reliable evaluation of ocular surface inflammation.
GLA Acts Synergistically in Treatment of Meibomian Gland Dysfunction
Meibomian Gland Dysfunction & Treatment
Meibomian gland dysfunction (MGD) is a common, yet often overlooked, chronic disease of the posterior eyelids. MGD is most often caused by an obstruction of the meibomian glands secondary to hyper-keratinization of the duct epithelium and plugging with a solidified secretion. These changes lead to alterations in the tear film lipid layer. Evaporation and tear osmolarity increase, resulting in dry eye signs and symptoms.
For patients with significant inflammation, systemic antibiotics and topical antibiotic/steroid combinations are used in the short term. Long-term treatment is aimed at controlling symptoms through eyelid hygiene.
Oral GLA May Enhance Hygiene Therapy
Supplementation with the omega-6 fatty acids linoleic acid and gamma-linolenic acid (GLA) has been reported to be of benefit in treating chronic inflammatory disorders such as rheumatoid arthritis. These fatty acids have also been found to reduce ocular surface inflammation and improve dry eye symptoms in patients with Sjögren’s syndrome and keratoconjunctivitis sicca.
In the present study, researchers assessed the effect of modest supplemental amounts of linoleic acid and GLA on MGD. The results suggest that oral fatty acids enhance eyelid hygiene in improving symptoms and reducing eyelid margin inflammation.
Fifty-seven patients with MGD (27 men and 30 women) were randomly divided into 3 groups of 19. Group A received linoleic acid (28.5 mg) and GLA (15 mg) daily, while group B performed eyelid hygiene each day. Group C received both treatments.
Initially and after 60 and 180 days of therapy, all patients completed a self-evaluation questionnaire on ocular surface disorders and underwent slit-lamp examination. The following signs were evaluated: eyelid edema, eyelid margin hyperemia, meibomian secretion appearance, meibomian gland obstruction, conjunctival hyperemia, conjunctival papillae, corneal staining, and foam collection in the tear meniscus. The appearance of foam in the tear margin is indicative of meibomian gland malfunction.
In total, 49 (86%) of the 57 patients completed the study; 2 patients dropped out at day 60, and 6 were lost at follow-up on day 180.
Significant improvement in symptoms occurred in all groups.
After 180-days, group A (oral fatty acids) showed reductions in meibomian gland obstruction (P = 0.0001) and secretion turbidity (P = 0.02), while group B (eyelid hygiene) had reductions in eyelid edema (P = 0.02), corneal staining (P = 0.01), secretion turbidity (P = 0.01), and meibomian gland obstruction (P = 0.0001).
In group C (combined therapy), the researchers noted reductions in eyelid edema (P = 0.003), corneal staining (P = 0.02), secretion turbidity (P = 0.0001), meibomian gland obstruction (P = 0.0001), and foam collection in the tear meniscus (P = 0.02).
The authors conclude that the combined omega-6 fatty acids and eyelid hygiene regimen improves symptoms and reduces eyelid margin inflammation in MGD more than either therapy alone.
The results suggest that the omega-6 fatty acids could play a dual role. They may have an anti-inflammatory effect and contribute to reducing eyelid edema, and the congestion of blood (hyperemia) in the eyelid margin and conjunctiva. In addition, the fatty acids may modify the lipid composition of meibomian secretion, which appears less turbid and dense after treatment. These changes may increase the effectiveness of eyelid hygiene.
The improvement in symptoms and clinical signs suggest that the fatty acids are a viable adjuvant therapy for standard treatment of MGD, and warrant further large-scale studies.
GLA and EPA Have Complementary Actions
The fatty acids gamma-linolenic acid (GLA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) affect cellular processes involved in inflammation, including the production of eicosanoids. Prostaglandins are the major eicosanoids that are produced from specific fatty acids during inflammation:
It’s well known that inflammation plays a role in ocular surface dryness. Most dietary supplements investigated in dry eye have tested GLA or EPA and DHA. However, combining these fatty acids may optimize their ability to modulate inflammation.
Human studies, for example, have demonstrated that the addition of EPA and DHA in a balanced ratio to GLA prevents elevations in serum arachidonic acid (1,2), thus leading to decreased levels of pro-inflammatory prostaglandin. A combination of omega-3 and omega-6 fatty acids also results in lower arachidonic acid in the retinas and exorbital lacrimal glands in animals (3). A recently published study (4) lends credence to the idea that a GLA, EPA and DHA combination may provide advantages to supplementation with fatty acids from either the omega-3 or omega-6 family alone.
Study Design and Methods
Female Lewis rats were fed diets containing 1) GLA; 2) EPA and DHA; or 3) a combination of GLA, EPA and DHA for 2 months before the induction of dry eye using a continuous delivery of scopolamine, and during scopolamine treatment. Two, 10 and 28 days after dry eye-induction, clinical signs of corneal dryness were evaluated in vivo using fluorescein staining. Major histocompatibility complex Class II (MHC-II) expression and mucin (rMuc5AC) production in the conjunctival epithelium were evaluated by immuno-staining. Lipids and prostaglandins were analyzed from the exorbital lacrimal gland.
Dietary supplementation of omega-6 (GLA) and/or omega-3 fatty acids (EPA and DHA) improved the clinical signs of dry eye, although at a moderate level. All three of the fatty acid enriched diets minimized the occurrence of corneal keratitis after 28 days of treatments, and all the diets partially prevented a decrease in mucin.
The combined omega-6 and omega-3 diet, however, led to a lower arachidonic acid content in phospholipids (where fatty acids are stored), and a higher dGLA content when compared to the GLA-only enriched diet.
Further, the over-expression of MHC II in the conjunctival epithelium caused by dry eye induction was significantly reduced only with the GLA + EPA + DHA diet after 28 days of treatment.
According to the study authors, these results point out the efficacy of combining omega-3 with omega-6 GLA. GLA, dGLA, EPA and DHA have all been described as decreasing inflammation by reducing the expression of MHC II and inhibiting the production of inflammatory cytokines such as TNF-a and IL-1ß. In this study, only the combined fatty acids reduced MHC II expression.
These findings are in agreement with those from a pilot clinical trial conducted by the same researchers (5). In this trial, 3-month treatment with combined GLA, EPA and DHA demonstrated improved symptoms, and suggested a beneficial effect on the clinical signs of ocular dryness. The authors state that GLA with EPA and DHA may be useful in a dry eye therapy strategy along with classical therapy such as artificial tears.
Dry Eye Common in Contact Lens Wearers
Contact lens wearers commonly report a sensation of 'dryness' - a symptom that often results in reduced wear time or discontinued use. In most cases of contact lens-induced dry eye, objective signs are lacking and a diagnosis is based on symptoms alone. However, it has been demonstrated that intolerant contact lens wearers show significantly reduced tear stability and volume compared to successful wearers.
A variety of conventional strategies have been employed to alleviate contact lens-induced dry eye including use of artificial tears, changing lens parameters, or preserving tears with punctal plugs. However, novel treatment strategies using anti-inflammatory or immune modulating agents may also be effective. A recent pilot study, for example, offers evidence that cyclosporine may be beneficial in contact lens intolerant patients (1).
Oral GLA of Benefit in Inflammatory Dry Eye
Another more 'natural' approach involves the use of supplemental gamma-linolenic acid (GLA), an omega-6 fatty acid with anti-inflammatory properties found in oils derived from black currant seeds and the evening primrose plant. Several small trials testing GLA and linoleic (LA) oil in dry eye syndrome with an inflammatory component report reduced ocular surface inflammation and symptom improvement (2,3). These beneficial findings led researchers to examine the effects of GLA in contact-related dry eye patients (4).
Study Design and Methods
In this randomized, double-blind controlled trial, 76 female soft contact lens wearers with documented dry eye or borderline dry eye (McMonnies score =10), were treated for 6 months with GLA (300 mg daily) from evening primrose oil (EPO) or placebo (olive oil).
Participants were examined at 3 time points: baseline and at 3 and 6 months. At each exam, subjects answered 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 GLA group showed a significant improvement in the specific symptom of 'dryness' at 3 and 6 months (p <0.01) as well as significant improvement in overall lens comfort at 6 months (p<0.01). Tear meniscus height was increased in the GLA group at 6 months relative to baseline (p<0.01), although all other objective signs were unchanged (See figures 2 and 4).
This study provides evidence for a beneficial effect of oral GLA in alleviating symptoms and improving overall lens comfort in patients suffering from contact lens associated dry eye. According to the authors, this may be via a reduction in ocular surface inflammation that has been previously documented in contact lens wearers. An effect on tear secretion could also be a contributing factor. The authors indicate that "future studies will investigate the efficacy of a combined preparation (GLA, EPA and DHA), since it is likely that omega-3 fatty acids could act synergistically with omega-6 to enhance the therapeutic effect of each fatty acid".
Inflammation: Friend and Foe
The acute inflammatory response defends against invading microorganisms and damaged cells, and is essential for wound healing & tissue repair. Chronic inflammation, however, damages tissues and can lead to or worsen chronic diseases such as arthritis, heart disease & dry eye syndrome.
GLA as an Anti-Inflammatory Nutrient
A recent review underscores the role of the fatty acid gamma linolenic acid (GLA) in modulating the inflammatory response (1). GLA has gained recognition over the last few decades for its anti-inflammatory and anti-cancer actions. Some key findings from controlled clinical trials include:
Sources & Rationale for Supplementation
Dietary intake of GLA is typically negligible as GLA is present only in trace amounts in some green leafy vegetables and nuts. Supplemental sources include the oils of: borage (Borage officinalis), 20-26% GLA; black currant (Ribes nigrum), 15-18%; and evening primrose (Oenoethera biennis), 8-12%. According to Tufts researchers, black currant seed oil is a preferred source because it contains 13-16% of the omega-3 fatty acid alpha-linolenic as well as GLA. Examining the effects of black currant seed oil (vs. placebo) in healthy elderly subjects, researchers from Tufts found that GLA reduced levels of PGE2 and improved immune function (2).
GLA is produced in the body as an intermediate in the metabolism of linoleic acid (LA). However this reaction is very slow and further restricted by alcohol use, stress, smoking, saturated and trans-fatty acid intake, and deficiencies of magnesium, vitamin B6 and zinc. These factors - as well as hypertension, arthritis, psoriasis and diabetes - impair the activity of delta-6-desaturase, the enzyme that converts linoleic acid to GLA. Administering oral GLA is a means to bypass this often inefficient and rate-limiting step in the metabolism of LA to GLA.
Anti-Inflammatory Mechanism of Action
GLA is rapidly converted to dihomo GLA (DGLA) which is incorporated into cell membrane phospholipids. When released by the action of the enzyme phospholipase A2, DGLA competes with arachidonic acid for the enzymes COX and LOX. Arachidonic acid is the omega-6 found abundantly in meat and dairy, and the precursor to pro-inflammatory eicosinoids like PGE2.
The COX products of DGLA include prostaglandins of series 1 (PGE1) and thromboxane A1. These products exert anti-inflammatory, anti-aggregation and vaso-dilatory actions.
A key LOX product of DGLA, 15-HETrE, inhibits production of leukotriene B4 from inflammatory cells including neutrophils. Some research suggests that DGLA may act directly on T-cells to modulate immune response in diseases such as rheumatoid arthritis.
Anti-Cancer Mechanisms of Action
Pre-clinical research indicates that the anti-cancer properties of GLA include: direct cytotoxic action on cancer cells, anti-angiogenic action in tumor cells, stimulation of apoptosis, gene activation, and the effects of DGLA eicosinoids. Preliminary clinical studies suggest that GLA may have benefit in some cancers. GLA injected directly into tumor cells of patients with advanced glioma significantly reduced tumor mass.
Safety of Supplemental GLA
Supplemental GLA has been safely administered in clinical trials at oral doses of 2.8 grams per day or less, for up to a year (3-5). GLA-rich oils have also been commonly used in the U.S. for over 20 years, with no reports of serious adverse events or effects (6).
Americans, who generally obtain an excess of omega-6 fats through over-consumption of meat, dairy, vegetable cooking oils and shortenings, are advised to consume more omega-3s from fatty fish and nuts. The amount of omega-6 fatty acids present in common doses of GLA-rich oil do not make a significant contribution to overall fat intake - typically about 67 grams daily for a 2000 kcal diet with 30% of calories from fats. Further, black currant seed oil contains a recommended ratio of omega-6 to omega-3 fats.
GLA & EPA: Complementary Actions
One concern related to DGLA, is that it could be further metabolized to arachidonic acid with subsequent pro-inflammatory effects. This is not relevant in inflammatory cells such as neutrophils, since these cells lack enzyme (delta-5-desaturase) activity needed to convert DGLA to arachidonic acid (7). Importantly, inflammatory cells from subjects supplemented with GLA produce significantly less pro-inflammatory leukotriene B4 (8,9) .
In contrast to inflammatory cells, high levels of supplemental GLA have been shown in some but not other studies to elevate serum arachidonic acid levels. Human studies, however, have demonstrated that the addition of fish-derived omega-3 EPA in a balanced ratio to GLA, blocks the activity of delta-5-desaturase and prevents elevations in serum arachidonic acid (10,11).
Co-ingesting similar levels of EPA and GLA increases cellular membrane content of both DGLA and EPA (precursor to anti-inflammatory eicosinoids). In short, this supplementation strategy successfully maintains the anti-inflammatory capacity of GLA and increases serum EPA, without causing accumulation of arachidonic acid.
Flaxseed oil is a concentrated source of omega-3 alpha linolenic acid. However, conversion of this fatty acid to EPA is limited, and further metabolism to DHA is very low or negligible (12). Typically, only 15-40% of alpha linoleic is converted to EPA This may, in part, explain why omega-3 fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, have been found to benefit cardiovascular disease outcomes in primary- and secondary-prevention studies (13). Thus GLA-enriched oils are more effectively paired with fish oil rather than flaxseed oil to promote the complementary actions of GLA and EPA.
Inflammation and Sjögren's Syndrome
Affecting more than 1.4 million Americans, Sjögren's syndrome is an autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva. The hallmark symptoms of the disorder are dry mouth and dry eyes. Sjögren's syndrome is also frequently associated with rheumatic disorders such as rheumatoid arthritis.
T-cell infiltration and markers of immune activation have been noted in both the conjunctiva and lacrimal glands of these patients. Topical anti-inflammatory treatment of patients with dry eye reportedly produces a significant reduction of activated lymphocyte in the conjunctiva, thus demonstrating the potential for anti-inflammatory treatment of dry eyes.
Anti-inflammatory Activity of GLA
Gamma-linolenic acid (GLA) and its precursor linoleic acid (LA) are essential fatty acids found in certain plant seed oils such as black currant seed oil. Oral administration of GLA and LA has been shown to have beneficial effects in the treatment of chronic inflammatory disorders such as rheumatoid arthritis, and several pilot studies conducted in the 1980's suggest that these fatty acids may also benefit the ocular status of patients with Sjögren's.
GLA is metabolized to dihomo-linolenic acid (DGLA), the immediate precursor of PGE1, an eicosanoid with known anti-inflammatory action. In addition, both GLA and DGLA modulate the immune responses by acting directly on T lymphocytes. Researchers from the University of Messina in Italy now report that modest amounts of supplemental GLA and LA raise PGE1 tear content in Sjögren's, and improve signs and symptoms of ocular discomfort in these patients.
Design and Methods
This randomized, double-blind, controlled trial involved 40 patients with primary Sjögren's Syndrome divided into 2 groups. One group received GLA (15 mg) and LA (112 mg) twice daily for 1 month (GLA group), while the other group received placebos. Subjects underwent 3 examinations: baseline (T0), after 1 month (T1), and 15 days after treatment was suspended (T2). At each exam, the following tests were performed: tear sampling from the inferior meniscus, TBUT, fluorescein stain of the ocular surface, and tear basal secretion. A symptom score was also obtained each time. PGE1 was evaluated by enzyme immunoassay, and PGE1 content of tears was the primary endpoint.
Tear PGE1 levels were significantly increased in the GLA group after 1 month of treatment. Fifteen days after treatment was halted, a significant reduction of the PGE1 levels toward baseline was observed. The symptom score was significantly lower in the GLA group after 1 month, with several symptoms (burning, foreign body sensation and dryness) remaining improved after treatment was stopped. The corneal fluorescein stain in this group also showed a significant improvement after the first month, which was sustained 15 days after treatment cessation.
No statistically significant differences were found for the other tests. In contrast to the GLA group, no statistically significant changes were noted in the placebo group at all examination time points. These results are summarized in the table below (group 1 = supplemented; group 2 = placebo).
According to the authors, these results indicate that supplemental GLA and LA effectively increases PGE1, an indicator of anti-inflammatory activity, improves ocular surface status and reduces dry eye symptoms.
Reference Aragona P, et al. Systemic omega-6 essential fatty acid treatment and PGE1 tear content in Sjogren's syndrome patients. Invest Ophthalmol Vis Sci 46:4474-9, 2005.
According to a report released in May, an estimated 18 million Americans now have diabetes and another 20 million have impaired glucose tolerance that can lead to the full-blown disease. The prevalence of type 2, in fact, has tripled in the last 30 years along with the steady upsurge in obesity. In addition to facing higher rates of heart disease and potential complications such as neuropathy and retinopathy, diabetics are also more likely to suffer from dry eye according to findings from a recent prospective study (1).
Researchers followed the medical records of nearly 160,000 patients, 22,382 of them diabetics, in one of Israel's largest HMOs for 1 year. All filled prescriptions for ocular lubricants were documented, and the proportion of ocular lubrication consumers among diabetic and non-diabetic patients aged 50 and older was compared. HbA1c was also measured to examine the relationship between glycemic control and lubricant use.
A significantly higher percentage of diabetics (21%) were shown to receive the medications compared with non-diabetics (14%) in all age groups and for both sexes (Fig 1). Significantly more diabetics were frequent users of the medication (> 12 filled prescriptions yearly) than were KCS patients without diabetes. A clear trend between higher lubricant use and poorer glycemic control, regardless of age, was also observed.
The findings suggest that blood sugar control is important in preventing or reducing KCS in diabetics. According to the authors, small vessel damage and autonomic neuropathy may reduce lacrimal gland function. Decreased corneal sensitivity, which interrupts tearing reflex, could also play a role.
Results from several small controlled trials report that supplemental gamma-linolenic acid (GLA) improves symptoms of dry eye in KCS and post PRK (2,3). While this fatty acid has not been evaluated specifically in diabetic patients, there is evidence that GLA metabolism is impaired in diabetes (4). Additionally, GLA (480 mg daily) has been shown in a placebo-controlled trial to improve diabetic neuropathy (5).
Figure1. Percent of diabetic and non-diabetic patients who
filled prescriptions for ocular lubrication, stratified by
age. The percent of diabetic patients prescribed lubrications
was statistically significantly larger than the percent of
non-diabetic patients (X2 test, P < .0001 for
all age groups).
Transitory dry eye is a common complication after PRK and LASIK, lasting longer in patients with pre-operative dry eye (1). The anti-inflammatory properties of the fatty acid gamma linolenic acid (GLA) have long been known, and recent studies report that supplemental GLA increases tear concentrations of anti-inflammatory prostaglandin E1 (2,3), and increases tear production while reducing dry eye symptoms in post-PRK patients (4).
Consistent with these findings, are the results from several preliminary investigations of HydroEye®*, reported by Frank A. Bucci Jr, MD at the 2002 and 2003 ASCRS meetings. In the first study, administration of HydroEye daily to 13 normal patients was found to increase mean tear lactoferrin levels by 60% at the end of 8 weeks. Additionally, 12 pre-LASIK patients given HydroEye daily 1-4 weeks prior to LASIK, experienced a 40% increase in lactoferrin when measured the day before the procedure.
In a follow-up study reported at ASCRS earlier this year (5), Dr. Bucci evaluated the effects of pre-treatment with HydroEye in 40 patients undergoing bilateral LASIK. Twenty patients with a history of evaporative or aqueous-deficient dry eye were assigned to take the daily recommended dose of HydroEye for one month before surgery, continuing for a month post-operatively.The remaining 20 patients, age-matched but with no prior history of dry eye, served as untreated controls.
Tear lactoferrin levels were measured (Tear Profile Analyzer) at baseline, on the day of the procedure, and at one day and one month after surgery. At the beginning of the study, the treated group had a higher incidence of ocular surface disease and a lower lactoferrin level than the control group (.95 vs. 1.1 ng/ml, respectively).
In the treated patients, mean lactoferrin increased a significant 32% during the pre-treatment period, becoming significantly higher (mean 24%) than the control group by the day of surgery. Lactoferrin levels dropped one day post-op in both groups. However the post-surgery decrease was less marked in the treated compared to untreated patients (.88 v .77 ng/ml respectively), with lactoferrin levels still 12% higher in those taking HydroEye. Lactoferrin rose in both groups during the month following surgery, with levels remaining slightly above baseline measurements in the treated group. No difference in lactoferrin was noted between the two groups at the end of this period.
Levels of tear lactoferrin, an indicator of ocular surface health, have been shown to be decreased in those with tear-deficient dry eye, according to the study's author. "Against that background, the results of this study support the pre-operative, prophylactic use of oral omega fatty acids in patients with mild to moderate risk for dry eye after LASIK," Dr. Bucci concluded.
*HydroEye is a patented formulation containing GLA, omega-3 fatty acids, antioxidant vitamin C, and other nutrients needed to convert fatty acids to anti-inflammatory prostaglandins.
PRK is known to cause a temporary reduction in corneal sensitivity, leading to tear film changes, lowered reflex tearing, and production of inflammatory cytokines and free radicals. Transitory dry eye is a common complication after PRK and LASIK, lasting longer in patients with preoperative dry eye (1).
The anti-inflammatory properties of the fatty acid GLA have long been known. Recent studies report that oral administration of GLA and LA leads to a significant increase in tear concentrations of anti-inflammatory prostaglandin E1 (2,3), and reduces the symptoms of dry eye (2). The aim of this study was to evaluate the effects of GLA and LA on tear production, tear fluorescein clearance, dry eye symptoms, and the ocular surface after PRK (4).
In this randomized, controlled trial, 31 patients received modest amounts of oral GLA and LA 3 days prior to 30 days after undergoing PRK. Another 29 patients underwent PRK without the supplement, serving as controls. The following measurements were made at baseline and at the end of the study period: symptom questionnaire, Schirmer 1 test, fluorescein clearance test using standardized visual scale and corneal fluorescein staining.
All 60 patients completed the study. Statistical analysis showed a significant mean difference between the groups for dry eye symptoms, fluorscein clearance, and Schirmer's results. Compared to controls, the treated group had lower symptom scores, greater Schirmer test values, and more favorable fluorescein clearance scores [See Figures 1-3]. Both groups showed no signs of corneal staining at baseline. While more areas stained in controls than treated patients at 1 month post-surgery (0.09 ± 0.10 vs. 0.25 ± 0.21 respectively), the difference was not significant. The researchers concluded that oral precursors of prostaglandin E1, GLA and LA, could be helpful in increasing tear production and clearance after PRK.
Figure 1. Results of symptoms questionnaire (mean score) before starting study (T0) and 1 month after PRK (T1). (*P<0.05)
Figure 2. Results of Schirmer 1 test (mm/5 min) before starting study (T0) and 1 month after PRK (T1). (*P<0.0001)
Figure 3. Results of fluorescein clearance test by means of visual scale (mean score) before starting study (T0) and 1 month after PRK (T1). (*P<0.0001)
Due to contact lens intolerance, dry eye is a major reason for patients to consider LASIK. Dry eye is also a common post-LASIK complication, with compromised tear function and ocular surface typically lasting for at least one-month after surgery. Recovery time after surgery is also increased when dry eye develops. These factors led a group of researchers to investigate whether preoperative dry eye affects the visual outcome and incidence of complications after LASIK, and whether it is a risk factor for severe dry eye after surgery.
The investigators divided 543 eyes (290 patients) into three groups: those without dry eye (NDE), those with probable dry eye (PDE), and subjects with definite dry eye (DE). Subjects were diagnosed for DE or PDE and categorized into one of the three groups according to the modified criteria of the Japanese Dry Eye Association, which included the Schirmer test with anesthesia, tear Break-Up Time (BUT), fluorescein and rose bengal staining of the ocular surface, and symptom assessment. Follow-up tests were performed at 3, 6, and 12 months after the procedure. To evaluate the effectiveness of LASIK correction, uncorrected (UCVA), best-corrected visual acuity (BCVA), and manifest refraction in the spherical equivalent were examined at 1, 3, 6, and 12 months.
No significant differences were found among the groups in UCVA and BCVA, except at 1 month, when UCVA was better in the NDE than in the DE group (p>.03). In the DE group, manifest refractive deviation was slightly larger than in the NDE group only at 3 months (p>.01).
The mean results of the Schirmer test were lower in both the DE and PDE subjects compared with the NDE group at all follow-ups after LASIK. Tear BUT was shorter in the DE compared to the NDE group before and at post-LASIK follow-ups. For ocular surface abnormality, fluorescein scores were higher in the DE than the NDE group before and after LASIK up through the one-year mark. Similar results were found with the rose bengal scores.
Dryness was significantly more severe for the DE group compared to the NDE group before LASIK and at 3, 6, and 12 months. This also held true for the PDE vs. the NDE patients at 6 months and 1 year (See figure 1).
The results indicate that the safety and efficacy of LASIK are not affected by preexisting dry eye status. However, preoperative dry eye is a risk factor for severe postoperative dry eye with lower tear function, more vital staining of the ocular surface, and more severe symptoms. Bottom line: those that start out with dry eye suffer more discomfort over a longer period. This is a significant problem, as more than 75% of the patients who undergo LASIK at their clinic have dry eye at the outset according to these investigators.
HydroEye® is a patented, oral nutritional formulation for dry eye relief. More than 2000 doctors recommend it to their dry eye patients, and many report that it helps reduce dry eye symptoms in their LASIK patients. HydroEye has been reported to increase lactoferrin levels (an indicator of ocular surface health) by a mean of 40% in pre-LASIK patients.
Figure 1 appears courtesy of Archives of Opthalmology, originally appearing in reference #1, above.
Studies have shown that dry eye patients experience a chronic inflammatory cycle, causing symptoms and impacting tear production. A Phase III FDA study of cyclosporine, an immunomodulatory drug, demonstrated that in moderate and severe cases of Sjögren's syndrome and keratoconjunctivitis sicca (KCS), markers of inflammation were significantly reduced from baseline following treatment with this drug. However, this potent immunomodulatory drug is not a first-line defense.
A more effective and preventive approach may be to address the biochemical basis of a healthy and intact tear film. Studies have shown that nutritional supplementation with omega-3 and omega-6 fatty acids and nutrient cofactors involved in the biosynthesis of the prostaglandin PGE1 result in reduced symptoms in dry-eye and KCS patients (1,2). PGE1 is necessary for tear secretion and also regulates inflammation. Essentially, in the event of reduction of PGE1 synthesis (due to a deficiency of omega-3 and omega-6 fatty acids), there is overproduction of series 2 prostaglandins (PGE2). Increased PGE1 production is anti-inflammatory because it down-regulates PGE2 production, and thus reduces over-reactive B-cell activity and may be a regulator of the arachidonic acid cascade. Wu and colleagues carried out a placebo-controlled study of the effect of dietary supplementation with black current seed oil (BCSO) on immune response in healthy subjects 65 years or older (3).
This was a randomized double-blind study. Forty patients were randomized to receive either 750 mg BCSO or 750 mg soybean oil. BCSO contains linoleic acid and 15% gamma-linolenic acid (GLA) - both omega-6 fatty acids, as well as the omega-3 fatty acids alpha-linolenic acid and stearidonic acid. The ratio of omega-3 to omega-6 fatty acids in BCSO is about 1 to 4. The level of vitamin E intake in both groups was controlled equally. Supplementation continued for 2 months.
BSCO supplementation, significantly increased plasma concentrations of gamma-linolenic acid (omega-6), alpha-linolenic acid (omega-3), and dihomo-gamma-linolenic acid compared with baseline. These increases were not evident in the control group. The BCSO group exhibited enhanced response to tetanus toxoid. In the BCSO group, stimulated PGE2 production was significantly reduced from baseline (488 ng/L to 258 ng/L). This was significantly (p<0.05) different from the control (soybean oil) group, which did not exhibit this reduction (Figure). The authors concluded that BCSO has a moderate immune enhancing effect attributable to reduction of PGE2 production.
This study and previous research suggests that the combination of omega-3 and omega-6 fatty acids in black current seed oil both results in increased PGE1, which both stimulates aqueous tear secretion and reduces the production of PGE2.
ScienceBased Health's HydroEye® is a proprietary blend of BCSO (rich in both omega-3 and 6 fatty acids), Cod Liver Oil (additional omega-3 fatty acids, Vitamin A, and eicosanoids), Vitamins B6 and C and Magnesium. This optimal ratio of omega-3 and omega-6 fatty acids along with the essential cofactors for the PGE-1 pathway, results in increased PGE1 production. PGE1 both stimulates aqueous tear secretion and reduces inflammation by down-regulating production of PGE2 (enhancing T-cell production and inhibiting over-reactive B-cells).
In the previous
EduFacts we summarized preliminary work by Horrobin and colleagues
(1) which indicated that an effective approach to the treatment
of dry eye disorders may be to address the biochemical basis
of an intact tear film. In this preliminary study the authors
had evaluated the use of supplemental intake of the essential fatty
acids (EFA); linoleic and gamma linolenic acids; vitamin
B6 ; and vitamin
C to treat dry eye. These nutrients are necessary components
of the pathway for biosynthesis of prostaglandin E1 (PGE1), which
is necessary for aqueous tear secretion by the lacrimal glands.
The rationale for their study was based on earlier research showing
that gamma linolenic acid (GLA),
an upstream metabolite of the EFA linoleic acid, was lower among
patients with Sjögren's Syndrome. This suggested a breakdown
in the biochemical pathway which might be remedied by supplying
linoleic acid and the vitamin cofactors involved.
Another controlled study of treatment with precursor EFAs was performed by Oxholm and colleagues on patients with primary Sjögren's Syndrome (2).
28 patients with primary Sjögren's Syndrome were studied in a "cross-over" clinical study. Each patient received either Efamol (73% cis-linoleic acid, 9% gamma linolenic acid) or placebo for 8 weeks. Dosing was 6 3g capsules daily. Then each patient was "crossed-over" and received the opposite treatment for 8 more weeks. The initial treatment assignment was randomly chosen for each patient and the study was double masked - neither patients nor clinicians knew the treatment given to the patient. Clinical tests for keratoconjunctivitis sicca (KCS) included Schirmer test, tear-break-up-time, and Bijstervald score. These tests were evaluated before and after treatment. A combined ocular score was also computed. In addition the levels of DGLA (a metabolite of linoleic acid produced during biosynthesis of PGE1) were measured in serum and in erythrocytes before and after treatment.
Statistically significant baseline-to-post-treatment improvement in the overall ocular score was found in the Efamol group (p<0.05). Fewer patients in the control group experienced improvement (baseline-to-post-treatment) in ocular score. Furthermore, levels of the metabolite Di-hommo-gamma linolenic acid (DGLA) were increased significantly in both plasma (25% increase, p<0.001), and erythrocytes (10% increase, p<0.05) during Efamol treatment but not placebo treatment.
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.
Health's HydroEye® is formulated to provide nutritional
components necessary to support tear film biosynthesis processes.
By providing necessary essential fatty acid precursors and the vitamins
acting as nutrient co-factors, HydroEye helps optimize tear production.
A study published in 1994 reported that supplemental GLA lowered triglycerides, increased levels of "good" HDL cholesterol and prolonged the time it takes for blood platelets to clump together- factors which may contribute to cardiovascular health.
Platelets in the blood have a sticky surface which allows them, along with other substances, to form blood clots when bleeding occurs, a process called coagulation. Since platelets are involved in the process of forming clots, the GLA contained in HydroEye could theoretically increase the effects of anti-coagulant and anti-platelet medications such as Coumadin, Plavix or aspirin. If you are taking "blood thinning" medications, your physician can perform a Prothrombin time, INR, or bleeding time test to measure how long it takes blood to clot. This will ensure that HydroEye can safely be added to your current drug regimen.
HydroEye provides the same omega-3s as flaxseed and fish
oil. HydroEye now features EPA
from highest-quality, USP verified fish oil. However, only HydroEye provides
(gamma linolenic acid). GLA
effectively promotes the body's production of anti-inflammatory compounds. Both
and the omega-3 from fish oils have anti-inflammatory actions, but only GLA
has been clinically shown to decrease dry eye symptoms.
Additionally, neither fish nor flaxseed oils contain other
important nutrients that are included in HydroEye: vitamin B6 and magnesium
to promote fatty acid metabolism, vitamin A to support the production of mucin
in the tear film, and the antioxidant vitamin C to help fight the free radicals
associated with inflammation.
Research suggests that the EE (Ethyl Ester) and TG
(triglyceride) forms of omega fatty acids from fish oil are absorbed about the
same when taken over several weeks or more. While some research measuring absorption
over just a single day or less found the TG form to be better absorbed, differences
disappear in studies that compared these forms over two weeks or more. SBH products
contain the EE form, as the EE form has been used in nearly every clinical trial
showing benefit for omega-3s from fish oil and is the choice for the National
Eye Institutes AREDS 2 trial now in progress. Learn
How Does HydroEye Compare to other dry eye products?
HydroEye has a long, successful track record providing
dry eye relief to tens of thousands of users and is one of the leading
dry eye products recommended by ophthalmologists and optometrists.
HydroEye's unique, patented formulation features
a balanced blend of omega fatty acids, which have been well established
to provide support for dry eyes as well as other health benefits. GLA,
a key omega fat in HydroEye, has been well studied and safely used for
over 20 years. GLA has gained attention in recent years for it's role
in dampening inflammation, an underlying cause of dry eye. Read about studies on GLA for dry eyes . HydroEye also contains omega-3
from the highest quality, USP-verified fish oil. EPA
additional anti-inflammatory support as well as benefits for macular and heart health. HydroEye has also been found to raise
levels of lactoferrin in LASIK patients. Read
summary of study. Additionally, HydroEye provides antioxidants and other key nutrients that support all 3 layers of the tear film.
Detailed Comparisons - Compare HydroEye with:
Restasis is topical form of cyclosporine that works
HydroEye works from the inside out
to reduce inflammation and support tear production. HydroEye and
Restasis are complementary and may be taken together.
Flaxseed Oil or Fish Oil (used separately)
"Next-generation HydroEye contains USP®-verified fish oil that, together with GLA from black currant seed, provides the optimum balance of essential fatty acids to support ocular surface health."
-Stephen C. Pflugfelder, MD
Director, Ocular Surface Center
Cullen Eye Institute at Baylor College of Medicine
"HydroEye is a unique and effective dry eye formulation that works internally to promote tear production and relieve dry eye symptoms. My patients have experienced excellent results with HydroEye.”
-Paul Karpecki, OD, FAAO
Research Director, Corneal Services and Ocular Disease, Koffler Vision Group, Lexington, KY
"I recommend HydroEye for many of my dry eye patients, especially high-risk LASIK patients. My research has shown that HydroEye increases lactoferrin by 40% within two weeks of administering the formulation."
-Frank A. Bucci, Jr., MD
Ophthalmologist and Cataract Surgeon, Wilkes-Barre, PA
"HydroEye is very well-tolerated, and the vast majority of users continue as long-term users. Our practice has seen clear-cut clinical improvement in HydroEye users."
-John Sheppard, MD, MMSc
Professor of Ophthalmology & Microbiology and Clinical Director
Thomas R. Lee Center for Ocular Pharmacology;
President, Virginia Eye Consultants
"Trying HydroEye has got to be one of the best decisions I've ever made in caring for my patients. I cannot tell you the number of people I've recommended it to and how many have told me how much it has helped their dry eyes. One patient had been using a dry eye supplement from one of your competitors for about a year before trying HydroEye. After about a month on the HydroEye she told me that while she still needed to use lubricating drops, her eyes were feeling better than they had in a long long time. Another is a young woman who works as a scrub nurse. She came in complaining that in the cold surgical suites, her eyes were so dry she couldn't keep them open to do her job. I suggested she try HydroEye. I called her about 3 weeks later to see if it was working for her and she was delighted with how comfortable her eyes felt.
Thanks for a great dry eye product for my patients.
-Michael L. Friedberg, O.D.
President, Optometric Professional Network
Optometrist, Sugar Land, TX
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"I have seen a great satisfaction in the patient’s comfort level and a large reduction in the frequency of teardrops needed on a daily basis. The HydroEye has given him the comfort of a normal life and activity for a 9 year old with the use of one pill daily. Myself, his parents and the patient are quite satisfied with the HydroEye therapy he is on."
-Max A. Henry, MD
Ophthalmologist, Columbus, IN
"Armed with such a powerful tool for supporting ocular surface health, I now prescribe HydroEye for all my LASIK patients starting one week prior to their procedure as well as for the plethora of patients with dry eyes in Southern California who are less likely to accept being dependent on eye drops, gels or ointments."
-Michael B. Brenner, MD, FICS
Director, Mulach-Brenner Eye Center, Los Angeles, CA
"I have found HydroEye to be a successful adjunct in some of our dry eye patients. You should see some effect in 3 to 4 weeks or sooner … I have several patients that describe a diminution in their dry eye symptoms …"
-J.E. "Jay" McDonald II, MD
McDonald Eye Associates, Fayetteville, AR
"A patient with severely dry eyes failed with topical treatment (lubricating drops) and punctual plugs. I started her on HydroEye capsules twice daily and she reported much improvement about one month later. I had been struggling with this patient's dry eye discomfort for years and I was excited to see that she had done so well with HydroEye nutritional supplements. I have also noticed that when prescribing HydroEye pre and post operatively for our LASIK patients, the incidence of postoperative dry eye, which was quite common, has significantly decreased. We will continue using HydroEye in our practice."
-Gerald P. Spindel, MD
Spindel Eye Associates, PC Derry, New Hampshire
"Artificial tears and ointments can alleviate dry eye symptoms, but HydroEye, taken orally, seems to treat the root of the problem"
-Richard L. Lindstrom, MD
Clinical Professor of Ophthalmology, University of Minnesota, Minneapolis
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What Patients are Saying about HydroEye
(Customer review from Amazon.com):
Good eye vitamins., November 26, 2012
"Great for my dry eyes. This is recommended by several eye surgeons in the local area. They are the best”
-Debbie Spellman (Amazon customer)
“I have been using HydroEye for about two months now. I have to tell you I was a skeptic to say the least. I have had dry eye problems for as long as I can remember. I have been on every kind of drops – and now for a couple of years Restasis – but to no avail! I was looking on the net and your product showed up... I was desperate for relief. In probably no more than two weeks I was not worrying about my eyes hurting!!! I did not chalk it up to the use of your product at first. Like I said, I have tried everything out there! And let me tell you: I have been using HydroEye and I can't remember my eyes feeling this great!!! Thank you for your product.”
-R. Lawing, NM
(Customer review from Amazon.com):
No More Dry Eyes, May 8, 2012
"This Is Truly A Wonderful Product. Hydroeye has made my dry eye problem diminish greatly!
I will continue to use this product...Love It!!!”
-drewur (Amazon customer)
"Hi, I would like to share my experience with taking HydroEye. I have an extreme case of dry eye that can make me pretty miserable. Taking two HydroEye pills twice a day has improved my life greatly. After I take them, I can feel moisture form in my eyes. Thanks to HydroEye, I no longer suffer from the pain of dry eyes. I plan on taking them for the rest of my life."
-K. Pyle, Santa Cruz, CA
"I have Glaucoma in both eyes and my Doctor asked me to order HydroEye soft gels to support my dry eyes. I have been taking the product since April,2009 and I can truly say I believe the HydroEye soft gels are improving my dry eyes. I will never be without my HydroEye."
-L. Rabideaux, Decatur, GA
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Top of what patients are saying about HydroEye
Prior to finding HydroEye, I had laser surgery on the tear ducts of my lower eyelids to close them up and create more tearing because my eyes were so dry. After that, I also used various eye drops and Restasis. HydroEye is the only thing I've found that really helps my discomfort. It was recommended by my opthalmalogist and has worked great for me!
-D. Palmer, Tempe, AZ
After suffering from dry eye, I was at my wit's end. My ophthamologist prescribed the correct eye drops, Restasis® and Lotemax®, both very expensive. She eventually plugged my tear ducts and when I continued to have problems she sent me to an ophthamologist who specialized in dry eyes. He agreed with all that the previous doctor had prescribed but he suggested that I try HydroEye. I bought a bottle in his office and he instructed me to order on your website in the future. I am happy to report that my dry eyes have improved tremendously and I am so happy to take a supplement that doesn't contain potentially harmful drugs. I will continue to use HydroEye and suggest that my daughter try the supplement suggested for the optic nerve, due to concerns for her optic nerve health.
-D. Niforos, Ramsey, NJ
"I just wanted to let you know that after six weeks of using Hydroeye I am free of artificial tears. I am a licensed optician, and I am 10 months post PRK [a vision-corrective laser surgery like LASIK]. Up until using Hydroeye I was using artificial tears every 2 to 3 hours. I have recommended your product to our staff optometrist who is considering recommending it to her post LASIK patients."
-R. Berard, Stonington, CT
"I just wanted to take a minute to tell you about my experience with HydroEye!!
I have had lasik twice. My eyes were so dry it scared the eye doctor!! He said my eyes looked like a dry desert under the scopes!! Plus, I am a flight attendant that flies international 12 hour flights in dry air, which added to the problem!
Someone suggested HydroEye and what a difference that has made for me! I still use eyedrops at times, but the HydroEye has been a lifesaver for me. I would recommend it to anyone with dry eyes!!!"
-C. Smith, Greenback, TN
(Excerpt from Prevention® Magazine):
Six years ago, when I was 40, I found I couldn't wear my contact lenses anymore. My eyes were rapidly getting drier and drier. I chose to get the LASIK procedure so I wouldn't have to wear thick glasses the rest of my life. After the procedure, my eyes were drier than ever and extremely uncomfortable. My opthamologist would even comment on how I had the driest eyes in her practice (this included older adults.) The situation became very worrisome for me and I was concerned about my vision and health of my eyes. I read horror stories of people having to wear fluid-filled devices against their eyes to prevent ulcers and visual damage. I was desperate.
All that changed after I read an itty bitty article in Prevention Magazine. It talked about a new product called HydroEye from a company called ScienceBased Health that I could access online. I jumped at the prospect of relief from this terrible situation. I ordered the product, received it in record time and began taking it. I started feeling relief in 2-3 weeks. My eyes got more moist and more comfortable by the day. I no longer carried eyedrops with me (they never helped past about 1 minute anyway). My vision became so much clearer since my corneas were now hydrated.
After a year or so, I got lazy and didn't order my Hyroeye in time and went off of it. Two weeks later I noticed that my eyes were becoming gritty and draggy again. I wondered what was going on (and felt very depressed about it) until I realized that I hadn't taken the supplement for a while. You can bet I reordered and will never forget again.
Please tell your readers about this marvelous product again. It has changed my outlook on my future and the comfort of my present life.
"Great Product! I have been using it for almost a year. At my last eye exam, my doctor was thrilled with the health of my eyes. After suffering with dry eyes for years, this is the one product that gives me relief. My doctor was also impressed with the product; he feels that I am benefiting from HydroEye.
-D. Dufault, Las Vegas, NV
"I would like to comment on the HydroEye capsules that your company sells. About 3 years ago, I started to experience severely dry eyes. So dry, that I could not wear my contacts anymore and was getting at least 3 eye infections every year. I did not know why and tried various routes to try and alleviate the problem. My current optometrist stated that she had not seen such dry eyes in a woman my age(I am 39 now). . . I came across your site through the internet and ordered Hydroeye at the beginning of October this year. I began to see results after taking the second bottle. My eyes can tolerate contacts and I haven't had the slightest sign of an eye infection yet. I hope others who have dry eyes can find this product, because it really does work."
-L. Sanders, Calgary, Alberta, Canada
"This is just a quick note to let you know how happy I am with HydroEye. I had reached a point at which I could only wear my contact lenses for 2 to 4 hours because of dry eyes, when a representative of your company told me about HydroEye. I had had this problem for years and didn't expect HydroEye to work but I tried it anyway. At first I didn't notice much difference. One night after taking HydroEye for about 6 weeks I noticed my eyes were a little irritated. I still had my contacts in at 9:00 p.m. I had put them in at 6:00 a.m. that morning. I wouldn't be without my HydroEye now. I wear my contacts for 14 hours a day now and love it. Thank you for making a great product."
-L. Johnson, Ophthalmic Technician, Indiana
I just wanted to let you know of my tremendous success with your product HydroEye. . .I was in excruciating pain every day. . . I was in so much discomfort that it affected my daily activities. I was irritable most of the time because of the discomfort I was in. . .For 2 years I suffered with this condition with no relief in sight. . .My Dr. stated he . . . would give me a bottle of these supplements. I was eager to try anything. I took the Hydro Eye supplement. . .I am totally pain and symptom free!!!!. . .I feel that this has been a miracle for me. I can now resume my normal activities without worrying about my eyes bothering me. . .Thank you again.
-C. Keyton, Ohio
"I never had dry eyes prior to my laser surgery in September of 1999. The Dr's (I have gone to two for help) were at a loss as to what they could do for me anymore. I had all four tear ducts plugged and still could hardly see. I was going through bottles of artificial tears (I had bottles on every floor of my home, my purse, my workplace), continually searching for relief. . . my Dr. said that I should at least try the HydroEye as a last attempt. She said that her "worst dry eye patient got relief from HydroEye". Of course, I was willing to try anything to be able to see again! After the first bottle, I began to see amazing results and having just finished my second bottle, I hardly ever use the artifical tears anymore and my eye comfort is amazingly wonderful! I am eternally grateful for this product and will tell everyone I know about it! Thanks again!"
-M. Gruber, Maryland
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"HydroEye is working great for me. I take one in the morning and another early afternoon. I am in front of a computer all day and HydroEye really helps!"
-R. Kotten, Colorado
"My eyes recently had laser surgery and they feel more comfortable when I'm taking my supplements. PLEASE hurry up the next shipment."
-D. Caldarere, Louisiana
"Am so glad to find HydroEye Available. Have used it for only 5 weeks and can see definite progress with my eyes. Had LASIK procedure 11/15/99 and have had a difficult time in healing, etc. Last 5 weeks have been a marked improvement. Thanks."
-P. Ingerson, New Hampshire
"I have had my tear ducts plugged and have used several eye lubricants. One month ago my eye doctor suggested HydroEye. Within 10 days my eyes felt much better. The eye doctor checked my eyes again and saw a marked improvement. I will always have dry eyes but HydroEye has made my eyes much better and more manageable."
-J. Christiansen, Nebraska
"I have suffered from dry eyes for about 1½ years. I carry artificial tears in my pocket. Recently, my son sent me a bottle of your new product HydroEye. Since I do volunteer work at the Lester Eye Center In Atlanta, GA, I decided to do a Schirmer test study before starting your product. We got a reading of 3 in the OD and 5 in the OS. I took the recommended dosage of 2 caps daily. After 2 weeks, we re-did the Shirmer and to each surface the results were 14 in the OD and 15 in the OS. I was also able to eliminate using the tears. I realize this is only a report of 1 but felt you might be interested in knowing."
-R. Loftus, Georgia
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"I am glad that you have this product, I have been suffering with dry eyes and this is a great relief."
-B. Lower, Utah
" I just wanted to tell you how much I like HydroEye. I've had dry eyes for years. My eye doctor said I have (well it has a long medical name) but in essence, I have dandruff in my eyelashes. I wash my eyes every night with baby shampoo, but still have to use artificial tears. My first order of HydroEye came and I started using it. I noticed that I didn't have to use the artificial tears as often. But then I let myself run out. By the time I re-ordered and you shipped my new supply, I was using those artificial tears really often. I'd even wake up at night and have to put some in. I won't let my supply run out again. Thank you for this great product."
-H. Duncan, California
"I have extremely dry eyes and have been using HydroEye for about 3 months with tremendous results. My ophthalmologist said my corneas look better that she has ever seen them look. . ."
-Sent to ScienceBased Health by e-mail.
Thank you for your response. The HydroEye has made a measurable difference for me based on an imaging test of some sort done at the Moran Eye Center. I recently had LASIK surgery and already had dry eyes before the surgery. I began taking the HydroEye about 2 days after the surgery and when I had my eyes tested again about 2 weeks later, the difference was quite plain to see. I ran out of the supplement about 10 days ago and I am quite miserable without the HydroEye support. I am looking forward to receiving the shipment. Thanks!"
"HydroEye is a real lifesaver!! It has cut my use of drops from a bottle a week to a bottle every few weeks! Thank you so much for researching and making this product available."
-E. Kaynor, Michigan
"I was delighted by the effectiveness of this doctor recommendation in improving my dry eye."
-M. Kaye, New Jersey
"My eye doctor recommended HydroEye for my dry eye condition. Of course Reno, NV is very dry and with middle age eyes I was having lots of problems. I have used it for about 3-4 years and I highly recommend it. The times I have forgotten to reorder it I can really tell a difference."
-M. Pruter, Reno, NV
"I have to say I was skeptical when my ophthalmologist suggested HydroEye for my dry eye condition. I wasn't sure how such a product could be much more than a placebo, but I figured it was worth a try. I am now a regular user. My dry eye is gone and much to my amazement, dry lips are gone too! Your product is a godsend to those of use in desert climates."
-W. Danton, Reno, NV
"I was looking for something to help with my dry eyes. Drops are O.K. but I wanted something more. When I discovered HydroEye it was the best thing that has happened for my dry eyes. Now I can go without drops most days. My eyes have never felt better. Thank you for putting together such a great selection of ingredients."
-B. Salmonsen, Warrington, PA
"My Doctor asked me to order Hydro Eye soft gels to support my dry eyes. I have been taking HydroEye soft gels since April, 2009 and I can truly say I believe the HydroEye soft gels are improving my dry eyes so much. I will never be without HydroEye soft gels."
"Years ago, I woke up with dry eyes. Bam. Not there one day – there the next. The dryness got so bad I had to quit wearing contact lenses and opted for Lasik. During the Lasik recovery period (in which eyes get even drier), I read an article on HydroEye in Prevention Magazine. I decided to try it and within 3 weeks, my eyes felt 100% more comfortable. My ophthalmologist even commented that they looked so much better. When I told her I was taking Hydroeye, all she said was "Well, I don't take advice from the back of magazines." Months went by and I returned for a follow-up visit and saw that she was selling HydroEye in her office! HydroEye has made what was a very uncomfortable situation, comfortable again. My vision is clearer and my level of comfort has been much improved. Thank you, Science Based Health! You guys are geniuses!"
-S. Robinson-Flugel, Glen Ellyn, IL
"I started using HydroEye several years ago, due to my severe dry eyes. I couldnt believe the difference it made!!! After a month, I actually had more fluid in my eyes, and as an added benefit, it also seemed to help with my over-all sense of well being-I was more relaxed. I’ve tried several other dry eye supplements, but none can compare. I have recommended this supplement to many others, all whom have had great results. I’m not sure what I would do without this product. It has been a lifesaver."
-D. Gursin, Harrison Twp, MI
"I had Lasik eye surgery done in 2006. After the surgery I suffered from dry eye, which the doctors said could happen. I tried regular fish oil with no positive results. I ordered HydroEye and soon I barely had any problems with my eyes being dry. I have been taking this product since 2006. I recommended it to a few friends as well. The best product. I also recommended the MacularProtect for my mother. My ophthalmologist had also heard about this product and said it was a good product."
-C. Stanley, Bolton, CT
"My ophthalmologist recommended HydroEye several years ago for a chronic dry eye problem. I've taken it faithfully ever since and believe that it helps keep my eyes moist. I like the combination of products for general health as well."
-V. Hawthorne, Mount Calm, TX
"I suffered greatly from dry itchy eyes, especially in dry climate. HydroEye has solved my problem. I hope I never have to live without it again."
-C. Satterwhite, Houston, TX
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