One of the most common but frequent consequences of hormonal changes associated with perimenopause and menopause is dry eyes. In fact, the majority of those who suffer dry eye, are midlife women and older. In one study, presented at the annual meeting of the North American Menopause Society, 96% of 582 women with dry eye symptoms were perimenopausal or menopausal. Unfortunately, only 27% of these women had actually been diagnosed with dry eye syndrome by a practitioner and most did not know that there was any relationship with menopause. In this same study 95% of gynecologists and primary care provider never asked about dry eyes during a medical history. Clearly, health care providers need more information about this common and problematic health care problem.
Dry eye is a condition in which there are either insufficient tears to lubricate the eyes or the tears are poor quality or there is an imbalance between tear production and drainage. Tears are essential for lubrication, to reduce the risk of eye infections, to wash away foreign bodies in the eye and to keep the eye surface smooth and clear. Symptoms of dry eyes include irritation, gritty/scratchy or burning eyes, sensation of something in the eyes, tearing and blurred vision. In advanced dry eyes, damage to the cornea can occur and even impaired vision.
There are some simple self care habits one can acquire to prevent and manage dry eyes:
- Blink regularly with prolonged reading and computer screen work- to spread the tears evenly over the eyes
- Take eye breaks- close eyes for a few minutes with reading, computer work that requires visual concentration
- Position computer screen below eye level-so that the eyes don’t open overly wide as it would if the screen was higher. A lower screen may help to slow the evaporation of tears between blinks
- Increase level of humidity indoors
- Sunglasses worn outdoors helps to prevent exposure to wind and sun
- Avoid dehydration
- Avoid air blowing in the eyes
- Warm wet compresses- applied over the eyes for five minutes then gently rub the washcloth over the eyelids to loosen any particulate debris.
- Mild soap wash with baby shampoo or another soap intended to wash the eyes. The soap is applied to clean fingertips and gently massed into closed eyes near the base of the eyelashes then rinsed.
Both flaxseed oil and fish oil have demonstrated some positive benefits in dry eye disease by decreasing inflammation and/or increasing tear production and/or decreasing the evaporation of the tears. Several studies have determined an association between the intake of omega-3 supplements and meibomian gland oils and the implication for dry eye disease. Meibomian gland oils have been positively influenced by dietary omega-3 intake in individuals with Sjogren’s syndrome. [i] In the Women’s Health Study, data from 32,470 women found that a low dietary intake of omega-3s and/or a high omega-6 to omega-3 ratio increased the risk of dry eye syndrome.[ii] In another study involving patients with Sjogren’s syndrome, researchers found that the severity of dry eye and dry mouth disease was inversely proportional to membrane and serum levels of docosahexaenoic acid (DHA). [iii] There have also been two published anecdotal reports of flaxseed oil improving dry eye symptoms and thinning meibomian gland secretions.[iv] , [v] In a randomized clinical trial, oral flaxseed oil improved ocular surface inflammation and tear tests in patients with rheumatoid arthritis or systemic lupus associated with Sjogren’s syndrome and dry eye.[vi] An omega-3 supplement combination of 450 mg EPA/300 mg DHA + 1,000 mg flax oil + 183 IU of vitamin E oil improved dry eye symptoms and increased salivary gland secretion in patients with dry eye and dry mouth associated with Sjogren’s syndrome.[vii] A pilot, prospective, randomized, double-masked study was conducted in 36 patients with dry eye. Patients received either a daily dose of fish oil (450 mg EPA, 300 mg of DHA) with 1,000 mg of flaxseed oil, or placebo for 90 days. [viii] By the end of the study, 90% had become asymptomatic in the treatment group and only 7% in the placebo group. While there was no effect of fish oil/flax oil on meibum lipid composition or aqueous tear evaporation rate, the average tear production and tear volume was increased in the fish oil/flax oil group. [ix] December, 2011, I wrote about a study on sea buckthorn oil for dry eyes. The effect of oral sea buckthorn (SB) oil was studied in 100 individuals ages 20-75 in a double-blind, placebo-controlled study.[x] Participants took 2 gm/day of SB oil or placebo oil for 3 months. Eighty six participants completed the study. While the SB oil in people with dry eyed participants for 3 months did not result in any changes in the fatty acid composition of the tears, it did have a positive effect on osmolarity and symptoms of dry eye including burning and redness.
Over the counter preservative free single vial eye drops are the mainstay of dry eyes, whether mild, moderate or severe. Other medications and/or procedures from eye specialists are also available when symptoms are not adequately addressed with self care, artificial tears and nutritional supplementation.
[i] Sullivan B, Cermak J, Sullivan R, et al. Correlations between nutriebnt intake and the polar lipid profiles of meibomian gland secretions in women with Sjogren’s syndrome. Adv Exp Med Biol. 2002; 506(pt AP: 441-447.
[ii] Miljanovic B, Trivedi K, Dana M, er al. Relation between dietary n-3 and n-6 fatty acids and clinically diagnosed dry eye syndrome in women. Am J Clin Nutr. 2005;82:887-893.
[iii]Oxholm P, Asmussen K, Wiik A, et al. Essential fatty acid status in cell membranes and plasma of patients with primary Sjogren’s syndrome. Correlations to clinical and immunologic variables using a new model for classification and assessment of disease manifestations. Prostaglandins Leukot Essent Fatty Acids. 1998;59:239-245.
[iv] Boerner C. Dry eye successfully treated with oral flaxseed oil. Ocular Surgery News. October 15, 2000: 147-148.
[v] Chan C, Boxer W. Evaluation of flaxseed oil and doxycycline on dry eye outcomes in patients undergoing LASIK. ASCRS Annual Meeting. March 2006. San Francisco, CA.
[vi] Pinheiro M, Dos Santos P, Dos Santos R, et al. Oral flaxseed oil in the treatment for dry-eye Sjogren’s syndrome patients. Arq Bras Oftalmol. 2007;70:649-655.
[vii] Papas A. Singh M. The effect of a unique omega-3 supplement on dry mouth and dry eye in Sjogren’s patients. ARVO Annual Meeting. 2007.
[viii] Wojtowicz J, Butovich I, Uchiyama E, et al. Pilot, prospective, randomized, double-masked, placebo-controlled clinical trial of an Omega-3 supplement for dry eye. Cornea 2011; 30(3):308-314.
[x] Jarvinen R, Larmo P, Setala N, et al. Effects of oral se buckthorn oil on tear film fatty acids in individuals with dry eye. Cornea 2011;30;9:1-13-1018.