Systemic Omega-3 Fatty Acid Levels Not to Blame for Dry Eye Disease

Omega 3 capsules.
A recent study finds no significant association between omega-3 levels and dry eye disease (DED) symptoms and only one sign of DED.

Patients with dry eye disease (DED) who had lower systemic levels of omega-3 did not show worse signs and symptoms of DED than patients with normal levels, according to a study published in Eye & Contact Lens. Although physicians have used omega-3 fatty acid supplementation to treat systemic inflammation, data culled from the Dry Eye Assessment and Management (DREAM Identifier: NCT02128763) study shows no significant association between the worsening of most signs and symptoms of DED and low omega-3 levels, researchers say.

The investigation evaluated the association between systemic omega-3 levels at baseline and the severity of signs and symptoms in patients who had participated in the DREAM study, which featured highly inclusive criteria to capture a broad spectrum of typical DED patients. This study included 520 participants from 27 academic optometry and ophthalmology practices in the United States. 

Researchers analyzed blood samples from DREAM study participants for omega-3 and omega-6 levels, measured by weight among all fatty acids and erythrocytes. These measurements were then compared with baseline ocular symptoms, which were measured via the ocular surface disease index (OSDI), and signs, including tear breakup time (TBUT), Schirmer testing, corneal staining, and conjunctival staining.

Statistical analysis revealed no significant association between DED symptoms measured using OSDI and omega-3 measurements. Meanwhile, lower docosahexaenoic acid (DHA) levels were associated with increased conjunctival staining (P =.007). Researchers noted an inverse relationship of borderline statistical significance (P =.014) between eicosapentaenoic acid (EPA) and TBUT, which increased in significance (P =.004) when excluding individuals who were taking an omega-3 supplement. No other statistical correlations were discovered.

The results suggest that omega-3 levels may not play a significant role in the cause and treatment of DED, contradicting previous views. 

The study was limited in that due to the enrollment criteria of the DREAM clinical trial in which only patients with a DED diagnosis were evaluated. Therefore, it has not been determined whether a population of individuals without DED would have had higher systemic levels of omega-3.

These results reflect other findings gleaned from DREAM study data. For instance, researchers point to a 2018 investigation showing that 1 year of supplementation resulted in no differences in DED signs or symptoms between patients who received 3000 mg of omega-3 supplements daily and those who received 5000 mg of an olive oil placebo.2

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


1. Kuklinski EJ, Hom MM, Ying GS, et al; DREAM Study Research Group. Associations between systemic omega-3 fatty acid levels with moderate-to-severe dry eye disease signs and symptoms at baseline in the Dry Eye Assessment and Management Study. Eye Contact Lens. 2021;47(1):2-7. doi:10.1097/ICL.0000000000000687.

2. The Dry Eye Assessment and Management Study Research Group. n-3 fatty acid supplementation for treatment of dry eye disease. N Engl J Med. 2018;378:1681–1690. doi:10.1056/NEJMoa1709691