Eye and Oral Care
Natural Supplements for Dry Eyes
A closer look at the evidence for using natural supplements for dry eyes
Dry eye can be a complex disease of the tears and eye surface resulting in symptoms of discomfort, impaired vision, and tear film instability. There are two main causes that dry eyes can be subdivided into:
- Low tear volume
- Accelerated tear evaporation
Dry Eyes Are Common and Costly
Around the world, the prevalence of people suffering from dry eye ranges from 7% to 33% and increases significantly with age. Dry eyes can have a negative impact on the quality of life of those with this disease and is often a chronic condition.
Of those patients with severe dry eye, it is estimated that less than 30% of patients use medicated drops to manage their symptoms, whereas approximately 60% opt for using artificial tears.
The management of dry eye causes a substantial economic burden, with annual costs estimated at $3.4 billion dollars in the United States. When considering additional indirect costs such as a reduction in the productivity of individuals with this disease, the costs increase to $55.4 billion.
Although most recommended treatments include artificial tears, tear stimulating drugs, or medicated eye drops, there are several natural remedies and prevention strategies that may help in preventing symptoms of dry eyes.
Curcumin is present in the Indian spice turmeric and has been found to have anti-inflammatory, antioxidant, and anti-tumor properties. In research studies in a laboratory, curcumin can reduce the expression and activation of inflammatory signals in skin cells that are typically responsible for alterations in tears at the eyes surface. Therefore, it is believed curcumin can be used to decrease the inflammation present in those with dry eye disease, as well as reduce symptoms. There are no clinical studies looking at curcumin and dry eyes.
There is evidence to suggest that vitamin D deficiency may contribute to dry eye syndrome, with data showing an association between dry eyes and serum levels of 25-hydroxyvitamin D. In an observational study involving 105 subjects with dry eye that were unresponsive to conventional treatment who also had vitamin D deficiency, supplementation with an injection of cholecalciferol was found to be effective in relieving the symptoms.
Vitamin D supplementation was found to promote tear secretion, reduce tear evaporation, and decrease inflammation on the eye surface and eyelid margin. Additional studies have also shown the benefit of oral vitamin D supplementation in relieving symptoms of dry eye even in those without vitamin D deficiency.
Oxidative stress may be involved in injury to cells of the eye surface causing surface inflammation that results in dry eye disease. Due to the role of oxidative stress, several antioxidants appear to improve the tear film and the symptoms patients experience with dry eye disease.
In a cross-over randomized controlled clinical study evaluating the effects of oral supplementation with a combination supplement composed of vitamin B2, C, E, selenium, and zinc, patients were found to have significant improvement in tear stability and also clinical symptoms of dry eye.
Another study evaluating the effects of an oral antioxidant supplement containing anthocyanosides, astaxanthin, vitamins A, vitamin C, vitamin E, and Chinese herbal extracts (Cassiae semen and Ophiopogonis japonicas) found increased tear production, improved tear film stability, and decreased dry eye symptoms in subjects receiving the supplement.
From these studies and those alike, it is evident that antioxidants play a role in treating dry eye. However, it is unclear if individual vitamins are more effective than others since the studies used combinations rather than studying individual vitamins.
Omega- 3 Fatty Acids
Omega-3 fatty acids are composed of eicosapentaenoic acid (EPA), docosahexanoic acid (DHA), and alpha-linoleic acid (ALA), and are essential fatty acids that cannot be synthesized by the human body, therefore requiring supplementation in the diet. These fatty acids play an essential role in eye health by way of their anti-inflammatory properties. Omega-3 fatty acids reduce cytokines and block inflammatory eicosanoids that have been shown to play a significant role in the disease process of dry eye.
Several studies have shown the benefit of omega-3 supplementation and dry eye disease.[12,13] One of the larger, prospective, randomized controlled clinical studies evaluated the role of omega-3 fatty acids in patients with diets that lacked omega 3-fatty acids. The results showed that oral supplementation with omega-3 fatty acids in a 500mg capsule form (325 mg EPA and 175 mg DHA) twice daily for 3 months both improved dry eye symptom and enhanced the tear-film-breakup time.
The cause of dry eye in some people is due to Meibomian gland dysfunction (the oil-producing glands along the eyelid) which results in increased evaporation of the tear film. Several clinical trials have investigated the use of hot compresses, eyelid warming masks/goggles, infrared heaters, and eyelid massage as a treatment for dry eye disease.[15-18] These therapies clinically improved dry eye by reducing Meibomian gland duct obstruction, and also increased tear film stability and lipid layer thickness of the tear film.[15-17]
Modifying the Environment
In addition, by modifying your environment by using humidifiers and avoiding air conditioning, sun, dust, and wind may also help to relieve dry eye symptoms by reducing the chance of inflammation.
Overall, despite the large number of people affected by dry eyes, there has yet to be an established treatment algorithm to effectively manage the symptoms experienced by those with the disease. Nevertheless, there seem to be several supplements that are promising. Although various types of medications are available, it is, in fact, possible that incorporating some of these natural supplements into the diet and modifying eyelid hygiene habits may prove to be effective in treating dry eye in some individuals.
- The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop. Ocul Surf. 2007;5:75–92. PMID:
- Gayton JL. Etiology, prevalence, and treatment of dry eye disease. Clin Ophthalmol.2009;3:405-412; PMID: 19688028 Link to research.
- Yu J, Asche CV, Fairchild CJ. The economic burden of dry eye disease in the United States: a decision tree analysis. Cornea.2011;30(4):379-387; PMID: 21045640 Link to research.
- Pescosolido N, Giannotti R, Plateroti AM, et al. Curcumin: therapeutical potential in ophthalmology. Planta Med.2014;80(4):249-254; PMID: 24323538 Link to research.
- Yoon SY, Bae SH, Shin YJ, et al. Low Serum 25-Hydroxyvitamin D Levels Are Associated with Dry Eye Syndrome. PLoS One.2016;11(1):e0147847; PMID: 26807908 Link to research.
- Bae SH, Shin YJ, Kim HK, et al. Vitamin D Supplementation for Patients with Dry Eye Syndrome Refractory to Conventional Treatment. Sci Rep.2016;6:33083; PMID: 27698364 Link to research.
- Yang CH, Albietz J, Harkin DG, et al. Impact of oral vitamin D supplementation on the ocular surface in people with dry eye and/or low serum vitamin D. Cont Lens Anterior Eye.2018;41(1):69-76; PMID: 28919183 Link to research.
- Dogru M, Wakamatsu T, Kojima T, Matsumoto Y, Kawakita T, Schnider C, et al. The role of oxidative stress and inflammation in dry eye disease. Cornea 2009;28:S70–4. PMID:
- Drouault-Holowacz S, Bieuvelet S, Burckel A, et al. Antioxidants intake and dry eye syndrome: a crossover, placebo-controlled, randomized trial. Eur J Ophthalmol.2009;19(3):337-342; PMID: 19396775 Link to research.
- Huang JY, Yeh PT, Hou YC. A randomized, double-blind, placebo-controlled study of oral antioxidant supplement therapy in patients with dry eye syndrome. Clin Ophthalmol.2016;10:813-820; PMID: 27274185 Link to research.
- Barabino S, Rolando M, Camicione P, et al. Systemic linoleic and gamma-linolenic acid therapy in dry eye syndrome with an inflammatory component. Cornea.2003;22(2):97-101; PMID: 12605039 Link to research.
- Brignole-Baudouin F, Baudouin C, Aragona P, et al. A multicentre, double-masked, randomized, controlled trial assessing the effect of oral supplementation of omega-3 and omega-6 fatty acids on a conjunctival inflammatory marker in dry eye patients. Acta Ophthalmol.2011;89(7):e591-597; PMID: 21834921 Link to research.
- Kangari H, Eftekhari MH, Sardari S, et al. Short-term consumption of oral omega-3 and dry eye syndrome. Ophthalmology.2013;120(11):2191-2196; PMID: 23642375 Link to research.
- Bhargava R, Kumar P, Kumar M, et al. A randomized controlled trial of omega-3 fatty acids in dry eye syndrome. Int J Ophthalmol.2013;6(6):811-816; PMID: 24392330 Link to research.
- Purslow C. Evaluation of the ocular tolerance of a novel eyelid-warming device used for meibomian gland dysfunction. Cont Lens Anterior Eye.2013;36(5):226-231; PMID: 23566749 Link to research.
- Matsumoto Y, Dogru M, Goto E, et al. Efficacy of a new warm moist air device on tear functions of patients with simple meibomian gland dysfunction. Cornea.2006;25(6):644-650; PMID: 17077654 Link to research.
- Olson MC, Korb DR, Greiner JV. Increase in tear film lipid layer thickness following treatment with warm compresses in patients with meibomian gland dysfunction. Eye Contact Lens.2003;29(2):96-99; PMID: 12695712 Link to research.
- Lee J. Systematic Review Of Thermal Massage Therapy For The Treatment Of Dry Eye Syndrome. Value Health.2015;18(7):A344; PMID: 26531950 Link to research.
- Wolkoff P, Nojgaard JK, Franck C, et al. The modern office environment desiccates the eyes? Indoor Air.2006;16(4):258-265; PMID: 16842606 Link to research.
- Khurana AK, Choudhary R, Ahluwalia BK, et al. Hospital epidemiology of dry eye. Indian J Ophthalmol.1991;39(2):55-58; PMID: 1916981 Link to research.