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New Proof that Dry Eye Omega Benefits Changes the Composition of the Meibum

Gregory Smith, MD, Wills Eye Institute

A pilot study of patients with blepharitis treated with omega-3 in the triglyceride form showed that oral treatment resulted in a change in the meibum composition. Furthermore, symptoms, osmolarity, tear break-up time, and blood saturation of omega-3 also improved. This study is in contrast to that of Wojtowicz et. al and Mascai who found no quantifiable change in meibum. One possible explanation for this is the use of omega-3 in the triglyceride form from marine sources rather that omega-3 in the ethyl ester form or alphalinoleic acid which is found in flax seed oil.

Marine oil typically undergoes purification with ethyl alcohol to remove mercury and other heavy metals that are now prevalent in these sources. As a side effect of this purification the normal triglyceride group is stripped from the molecule. This results in the omega-3 being in the ethyl ester form (how the vast majority of OTC omega-3s are sold). Physician Recommended Nutriceuticals subjects the purified oil to a re-esterification process that restores the triglyceride group to the omega-3.

J. Dyerberg has shown that the absorption of omega-3 rTG is much higher than that of omega-3 in the ethyl ester form. In his study using unpurified fish oil as a control (thus achieving 100% absorption), an omega-3 ethyl ester was absorbed at 72% and omega-3 triglyceride was absorbed at 124%. It would therefore be expected that higher blood levels of omega 3 would result in higher levels of Omega 3 in the meibum.

Flax seed oil with the omega-3 in the alphalinoleic acid form has been shown to be very difficult to convert to EPA and DHA. While certain groups (e.g. reproductive age females and vegetarians) may have a higher conversion rate of ALA to EPA and DHA, the overwhelming majority of the population can only convert at a rate of <1-2%. Mascai used 6 grams per day of flax seed oil and did not show a change in the meibum. (6) The low absorption rate compared to that of the omega 3 rTG may also explain this difference.