Dry eyes…do you suffer? Most people do or will at some point in their lifetime. I see many patients with dry eye symptoms like the following:

  • gritty eyes (feels like sand or gravel in the eyes)
  • red eyes
  • watery eyes

red dry eye

Most of these patients have symptoms that can be mild to severe. Many won’t even tell me of their issues as they just deal with it and use
artificial tears. Some people believe this is just how it is…especially contact lens wearers and allergy sufferers.

But…there is usually something else causing their issues…

I was catching up on my emails and came across an eblast from Optometric Physician by Dr. Art Epstein. Great read on Omega-3s and vitamin therapy for dry eyes. Here is a summary of what I learned and thought it was important to pass it along.


A Fish Story – by Art Epstein (summarized)

Today, we explore nutrition and its role in dry eye and its management – specifically, the importance of Omega-3 supplementation.


Many patients with dry eye suffer due to meibomian gland dysfunction (our eyelid’s oil glands do not secrete healthy oils if any at all). Hence, the value of Omega-3 vitamins has evolved and has become an effective treatment regimen. Most doctors will prescribe 2 gel caps/day, but some will not note much clinical improvement. So why was there no or minimal effect? Not all vitamins are created equal.

omega 3 pills

Prescribing the proper vitamins is crucial to improved symptoms and clinical results.

“EPA and DHA in Omega-3s are the building blocks of normal, functional meibum and their absence or insufficiency contributes to Meibomian Gland Dysfunction (MGD) that drives most dry eye. Most patients require 2.5 grams daily for normal meibomian gland function.”

How Omega-3s Are Produced

Omega-3 fish oil supplements are made using a distillation process. Extracted oils are mixed with ethanol and then distilled much like whiskey. The resulting Omega-3s are purified, but have been transformed from a natural triglyceride to an ethyl ester form in the process. Most Omega-3 products are directly encapsulated and sold in this form to keep production costs down. Unfortunately, ethyl ester forms are not readily absorbed or bioavailable resulting in low blood and tissue concentrations and digestive unpleasantness that patients frequently complain of.

A small handful of manufacturers add an additional and costly re-esterification step to return the oil to a cleaned triglyceride (rTG) form, which is easily absorbed, and bioavailable.

Prescribing Omega-3s


Recognizing that the overwhelming majority of “dry eye” patients actually suffer from dysfunctional rather than inadequate tears has been an epiphany. In turn, most tear dysfunction and patient misery arises from MGD and deficient tear lipids. This is true even for patients with Sjögren’s syndrome and other aqueous deficiency diseases. Lipid deficiency can also lead to additional evaporative stress causing further gland dysfunction.

pills and food

While it is one tool among many, it can be the single most important element in dry eye protocol. Cleaned triglyceride based omega-3s (rTG) provide numerous benefits ranging from normalizing lipid production, improved tear stability, reduced surface inflammation and a host of other ocular and systemic health benefits.

“I take dry eye omegas myself and it has significantly reduced shoulder pain from an old rotator cuff injury. My cholesterol and triglycerides have lowered to the point where I no longer take prescription statins. I not only consider it the foundation of my dry eye protocol but it has made a difference in my own health.”



For more information on Dry Eyes and Omegas, please email us at
info@uptowneyesnwa.com. ​
​If you have dry eye issues and would like more specific brands of Omegas,
we would be happy to discuss them with you at any time. Just call our
office at 479.966.4232 or email us at info@uptowneyesnwa.com.