Antioxidants for Dry Eye

Article by Don Goldberg

Tears lubricate and protect the eye, but age, ill health, and the environment can reduce the quality and quantity of tears. In this study, 43 people with dry eye took a daily antioxidant supplement or a placebo for eight weeks.
The supplement contained 2 mg astaxanthin, 120 mg bilberry extract, 1,500 IU vitamin A, 50 mg vitamin C, 110 mcg selenium yeast, 10 mg zinc gluconate, B-complex vitamins, 45 IU  vitamin E, 200 mg goji berry, and 200 mg cassia seed.
After eight weeks, those taking the antioxidant supplement had lower levels of damaging reactive oxygen species in tears, levels of which had increased for placebo. Also in the antioxidant group, tears took longer to evaporate and there was less pain, burning, and itching.

Reference: Clinical Ophthalmology; 2016, No. 10, 813-20

Additional Comments From Sam Forbes, CN.
Dry eye syndrome is a disorder of tear deficiency or excessive tear evaporation resulting in an unstable tear film. Symptoms include dryness, burning sensation, visual disturbance, and sandy-gritty eye irritation. Treatments usually include the use of artificial tears and anti-inflammatory drugs. Oxidative stress and inflammation, the usual culprits in most diseases, obviously play a role here, so the use of antioxidants is warranted. The eyes are especially vulnerable to aging and inflammation and exposure to free radicals can damage tear secreting glands and tissues. Properly formulated eye supplements designed to protect and maintain eye health, contain many of the ingredients used in this study and should provide similar therapeutic results; I’ll give examples after my comments. In other studies, it has been shown that omega-3 fatty acids from fish oil has demonstrated to be beneficial in dry eye syndrome. The use of both omega-3 fatty acids and antioxidants may be the best approach. Two components of the study, astaxanthin and goji berry, are not usually found in eye formulas and may have to be taken separately. Here are a few eye health formulas I suggest you try:

Vision Optmizer by Jarrow
90 Capsules - Product Code: 36604

Eye Antioxidant by Bluebonnet
120 VCapsules - Product Code: 52685

Advanced Eye Factors by Natural Factors
60 Capsules - Product Code: 55338

Goji 12:1 400 mg by Paradise Herbs
60 VCapsules - Product Code: 52436

Astaxanthin 4 mg by Healthy Origins
60 VSoftgels - Product Code: 66306


Inflammation and oxidative stress may play a key role in the development of dry eye syndrome.13,19,20 Omega-3 polyunsaturated fatty acid supplementation has been shown to potentiate the antioxidant defenses, to relieve the bothering symptoms and signs of eye dryness by improving the lubrication and tear stability, and to reduce the ocular surface inflammation in patients with glaucoma,21 in patients with pure dry eye,22–24 in patients suffering from meibomian gland dysfunction,25,26 and in patients after photoreactive keratectomy.27

The cornea is protected from oxidant damage by several primary scavengers in the tears, such as glutathione peroxidase, superoxide dismutase, and catalase.20 The protection of the cornea or conjunctival epithelial cells by this antioxidant mechanism may be limited in patients with DES. Several studies have shown that, in patients with DES, oxidative stress markers increase in tears and the conjunctival cells, and the levels of antioxidant enzyme decrease.21,22 Oxidative stress could potentially play a causative role in the inflammatory process and pathogenesis of dry eye.23
Inflammation may cause dysfunction in the cells responsible for tear secretion or retention and leads to ocular surface disease.
Free radicals can attack the cellular plasma membrane and cause cell damage and death.13 They can also damage the epithelial tissues of the conjunctiva, the lacrimal glands, and tear-secreting tissues. Exposure to ozone can degrade tear proteins and cause chronic dysfunction of the tear film.14 Antioxidants can protect against free radicals and may help conjunctival tissues in the provision of a stable tear film.15
Overall subjective impression revealed a significant improvement with treatment compared with placebo
Dry eye syndrome (DES) is a disorder of tear deficiency or excessive tear evaporation resulting in an unstable tear film. Typical symptoms comprise dryness, burning sensation, visual disturbance, and sandy-gritty eye irritation. Dry eye is associated with chronic inflammation in the functional unit of the lacrimal gland–ocular surface and can damage the ocular surface. The prevalence of DES increases with age and affects approximately one-third of the elderly population.1,2 Traditional treatments for DES are supplementation of artificial tears or punctal occlusion, in order to increase the volume of the tear film or reduce drainage.3 However, artificial tear substitutes can only temporarily relieve dry eye discomfort. Inflammation has been shown to play a role in DES; therefore, anti-inflammation medications, such as short-term steroids or long-term cyclosporine A, have demonstrated promising results.3–5
Dietary nutrients have been shown to be involved in the pathogenesis of DES.6,7 Essential fatty acids play a role in the inflammation process.8 Systemic omega-3 can mediate inflammation and has been used to treat DES, particularly in cases associated with meibomian gland dysfunction.9,10 Oral antioxidants, such as vitamin A or multivitamins, can improve tear film stability and the health of the conjunctival surface.11,12 Free radicals can attack the cellular plasma membrane and cause cell damage and death.13 They can also damage the epithelial tissues of the conjunctiva, the lacrimal glands, and tear-secreting tissues. Exposure to ozone can degrade tear proteins and cause chronic dysfunction of the tear film.14 Antioxidants can protect against free radicals and may help conjunctival tissues in the provision of a stable tear film.15
In this study, we evaluated the efficacy of an oral antioxidant supplement (a combined formula of antioxidants and crude extracted additives from several herbal plants) in the treatment of DES, compared with placebo. We also evaluated the activity of its antioxidants by measuring reactive oxygen species (ROS) in tears.

Omega-3 fatty acid supplementation improves dry eye symptoms in patients with glaucoma: results of a prospective multicenter study
Kaya A, Aksoy Y
Clinical Ophthalmology 2016, 10:911-912
Published Date: 18 May 2016
ORIGINAL RESEARCH

A randomized, double-blind, placebo-controlled study of oral antioxidant supplement therapy in patients with dry eye syndrome.
Huang JY, Yeh PT, Hou YC Clinical Ophthalmology 2016, 10:813-820