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Cited by 274Ocular Surface and Contact LensFatty Acid Research and HealthRetinal Diseases and Treatments

n−3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease

Open access
The Dry Eye Assessment and Management Study Research Group·2018·New England Journal of Medicine
DOI 10.1056/nejmoa1709691PMC PMC5952353
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Abstract

BACKGROUND: Dry eye disease is a common chronic condition that is characterized by ocular discomfort and visual disturbances that decrease quality of life. Many clinicians recommend the use of supplements of n-3 fatty acids (often called omega-3 fatty acids) to relieve symptoms. METHODS: In a multicenter, double-blind clinical trial, we randomly assigned patients with moderate-to-severe dry eye disease to receive a daily oral dose of 3000 mg of fish-derived n-3 eicosapentaenoic and docosahexaenoic acids (active supplement group) or an olive oil placebo (placebo group). The primary outcome was the mean change from baseline in the score on the Ocular Surface Disease Index (OSDI; scores range from 0 to 100, with higher scores indicating greater symptom severity), which was based on the mean of scores obtained at 6 and 12 months. Secondary outcomes included mean changes per eye in the conjunctival staining score (ranging from 0 to 6) and the corneal staining score (ranging from 0 to 15), with higher scores indicating more severe damage to the ocular surface, as well as mean changes in the tear break-up time (seconds between a blink and gaps in the tear film) and the result on Schirmer's test (length of wetting of paper strips placed on the lower eyelid), with lower values indicating more severe signs. RESULTS: A total of 349 patients were assigned to the active supplement group and 186 to the placebo group; the primary analysis included 329 and 170 patients, respectively. The mean change in the OSDI score was not significantly different between the active supplement group and the placebo group (-13.9 points and -12.5 points, respectively; mean difference in change after imputation of missing data, -1.9 points; 95% confidence interval [CI], -5.0 to 1.1; P=0.21). This result was consistent across prespecified subgroups. There were no significant differences between the active supplement group and the placebo group in mean changes from baseline in the conjunctival staining score (mean difference in change, 0.0 points; 95% CI, -0.2 to 0.1), corneal staining score (0.1 point; 95% CI, -0.2 to 0.4), tear break-up time (0.2 seconds; 95% CI, -0.1 to 0.5), and result on Schirmer's test (0.0 mm; 95% CI, -0.8 to 0.9). At 12 months, the rate of adherence to treatment in the active supplement group was 85.2%, according to the level of n-3 fatty acids in red cells. Rates of adverse events were similar in the two trial groups. CONCLUSIONS: Among patients with dry eye disease, those who were randomly assigned to receive supplements containing 3000 mg of n-3 fatty acids for 12 months did not have significantly better outcomes than those who were assigned to receive placebo. (Funded by the National Eye Institute, National Institutes of Health; DREAM ClinicalTrials.gov number, NCT02128763 .).

AI snapshot

Written from the paper’s full text.

TL;DR

In the DREAM multicenter, double-blind trial, daily supplementation with 3000 mg of fish-derived n–3 fatty acids for 12 months did not significantly improve dry eye symptoms or signs compared with olive oil placebo. The primary OSDI mean-change difference was −1.9 points (95% CI, −5.0 to 1.1; P=0.21).

Key findings

  • The primary outcome, mean change from baseline in OSDI score, was −13.9±15.6 points with active supplement vs −12.5±18.2 points with placebo; mean difference in change after multiple imputation was −1.9 points (95% CI, −5.0 to 1.1; P=0.21).
  • Secondary sign outcomes showed no significant differences: conjunctival staining score mean difference 0.0 points (95% CI, −0.2 to 0.1), corneal staining score 0.1 point (95% CI, −0.2 to 0.4), tear break-up time 0.2 seconds (95% CI, −0.1 to 0.5), and Schirmer’s test 0.0 mm (95% CI, −0.8 to 0.9).
  • Adherence at 12 months was 85.2% in the active group according to red-cell n–3 fatty acid levels; 83.0% of active-group and 82.9% of placebo-group patients reported taking five capsules daily.
  • Adverse event rates were similar: serious adverse events occurred in 6.0% of active vs 8.1% of placebo patients (P=0.31); diarrhea was reported in 4.9% vs 1.6% (P=0.09).

Methods

  • Multicenter, double-blind, randomized trial at 27 U.S. clinical centers; 349 patients assigned to active supplement and 186 to placebo in a 2:1 ratio, with moderate-to-severe dry eye disease and OSDI eligibility criteria of 25–80 at screening and 21–80 at confirmation.
  • Intervention was five soft-gelatin capsules daily for 12 months: active capsules contained 400 mg EPA and 200 mg DHA each (total daily dose 2000 mg EPA plus 1000 mg DHA); placebo capsules contained refined olive oil.
  • Primary analysis was intention-to-treat for mean change in OSDI score based on 6- and 12-month values; linear regression with robust variance, generalized estimating equations for ocular measures, multiple imputation for missing OSDI scores, and prespecified subgroup interaction tests were used.

Limitations

  • The paper does not include a formal limitations section; it states that the placebo effect was substantial, as in other dry eye trials.
  • The text notes that direct comparison with previous n–3 trials is complicated by differences in eligibility criteria, dose, placebo content, duration, use of other dry eye treatments, dietary practices, and outcome measures.
  • The trial allowed patients to continue existing dry eye treatments and included a broad spectrum of patients, which the authors present as supporting generalizability but which also means the results apply to n–3 supplementation added to ongoing care.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1056/nejmoa1709691

Cites

25 of 25 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

8 of 17 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured

  • Findingcitation

    Of 375 DREAM patients with tear osmolarity measurements, only 24 (6.4%) would have met the eligibility criteria of a recent study (osmolarity ≥312 mOsm/mL in at least one eye and mild meibomian-gland dysfunction in both eyes).

    “of the 375 patients in the DREAM trial who had tear osmolarity measurements, only 24 (6.4%) would have met the following eligibility criteria in a recent study: an osmolarity of at least 312 mOsm per milliliter in at least one eye and mild meibomian-gland dysfunction in both eyes.20”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [20] Epitropoulos AT Donnenfeld ED Shah ZA Effect of oral re-esterified omega-3 nutritional supplementation on dry eyes Cornea 2016 35 1185 91 27442314 PMC4975557 source

      The Materials and Methods section (page not available) identifies this as a study requiring tear osmolarity of at least 312 mOsm/L in one eye, so the citation identifies the recent study and its threshold. But it includes MGD stages 1 or 2, does not specify MGD in both eyes, and requires the osmolarity threshold on two visits. The 24-of-375 DREAM calculation is not a result attributed to this source. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Premisecitation

    Most previous randomized, placebo-controlled trials of n-3 fatty acids for dry eye disease showed significantly greater improvement in symptoms or in at least one sign in the n-3 group than in the placebo group.

    “Most of these trials showed significantly greater improvement in symptoms or in at least one of several signs of dry eye disease in the n–3 fatty acid group than in the placebo group.15,18–22,24,26”
    Quote in the paperSubstantial claim5 of 8 sources checked
    • cites [15] Bhargava R Kumar P Kumar M Mehra N Mishra A A randomized controlled trial of omega-3 fatty acids in dry eye syndrome Int J Ophthalmol 2013 6 811 6 24392330 PMC3874521 source
    • cites [18] Bhargava R Kumar P Oral omega-3 fatty acid treatment for dry eye in contact lens wearers Cornea 2015 34 413 20 25719253 source
    • cites [19] Deinema LA Vingrys AJ Wong CY Jackson DC Chinnery HR Downie LE A randomized, double-masked, placebo-controlled clinical trial of two forms of omega-3 supplements for treating dry eye disease Ophthalmology 2017 124 43 52 27817918 source
    • cites [20] Epitropoulos AT Donnenfeld ED Shah ZA Effect of oral re-esterified omega-3 nutritional supplementation on dry eyes Cornea 2016 35 1185 91 27442314 PMC4975557 source
    • cites [21] Kangari H Eftekhari MH Sardari S Short-term consumption of oral omega-3 and dry eye syndrome Ophthalmology 2013 120 2191 6 23642375 source
    • cites [22] Kawakita T Kawabata F Tsuji T Kawashima M Shimmura S Tsubota K Effects of dietary supplementation with fish oil on dry eye syndrome subjects: randomized controlled trial Biomed Res 2013 34 215 20 24190233 source
    • cites [24] Malhotra C Singh S Chakma P Jain AK Effect of oral omega-3 fatty acid supplementation on contrast sensitivity in patients with moderate meibomian gland dysfunction: a prospective placebo-controlled study Cornea 2015 34 637 43 25909236 source
    • cites [26] Sheppard JD Jr Singh R McClellan AJ Long-term supplementation with n-6 and n-3 PUFAs improves moderate-to-severe keratoconjunctivitis sicca: a randomized double-blind clinical trial Cornea 2013 32 1297 304 23884332 source
  • Premisecitation

    Aside from several large trials conducted in India by Bhargava et al., previous clinical trials involved fewer than 125 total patients.

    “Aside from several large trials that were conducted in India by Bhargava et al.,15–18 the previous clinical trials involved fewer than 125 total patients.”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [15] Bhargava R Kumar P Kumar M Mehra N Mishra A A randomized controlled trial of omega-3 fatty acids in dry eye syndrome Int J Ophthalmol 2013 6 811 6 24392330 PMC3874521 source
    • cites [16] Bhargava R Kumar P Phogat H Kaur A Kumar M Oral omega-3 fatty acids treatment in computer vision syndrome related dry eye Cont Lens Anterior Eye 2015 38 206 10 25697893 source
    • cites [17] Bhargava R Chandra M Bansal U Singh D Ranjan S Sharma S A randomized controlled trial of omega 3 fatty acids in rosacea patients with dry eye symptoms Curr Eye Res 2016 41 1274 80 27050028 source
    • cites [18] Bhargava R Kumar P Oral omega-3 fatty acid treatment for dry eye in contact lens wearers Cornea 2015 34 413 20 25719253 source
  • Findingown data

    The percentage of patients with at least one nonserious adverse event was 61.9% in the active group and 60.8% in the placebo group (P=0.87).

    “The percentage of patients with at least one nonserious adverse event was similar in the active supplement group and the placebo group (61.9% and 60.8%, respectively; P = 0.87)”
    Quote in the paperNot a substantial claim
  • Findingown data

    The mean difference in OSDI change was −1.6 points (95% CI, −4.8 to 1.6; P=0.32) in the analysis adjusted for baseline EPA level.

    “and was −1.6 points (95% CI, −4.8 to 1.6; P = 0.32) in an analysis performed with adjustment for the baseline EPA level (which included 486 patients)”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 20
  • May combine two claims. 15

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Many clinicians recommend and many patients take dietary supplements of n-3 fatty acids because they have antiinflammatory activity and are not associated with substantial side effects.

    “Many clinicians recommend and many patients take dietary supplements of n–3 fatty acids (often called omega-3 fatty acids), because they have antiinflammatory activity and are not associated with substantial side effects.6”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [6] Serhan CN Chiang N Van Dyke TE Resolving inflammation: dual anti-inflammatory and pro-resolution lipid mediators Nat Rev Immunol 2008 8 349 61 18437155 PMC2744593 source

      The discussion of omega-3 PUFAs (page not provided) reports beneficial effects in inflammatory diseases, supporting the anti-inflammatory rationale. Our copy does not establish that many clinicians recommend supplements or that many patients take them. The concluding discussion (page not provided) raises the possibility that excess DHA and EPA intake could damage tissues, so it does not support the claim that supplements lack substantial side effects. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Changes in mean visual acuity and mean intraocular pressure were not significantly different between groups.

    “as were the changes in mean visual acuity and mean intraocular pressure.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The mean change in total OSDI score was −13.9 points in the active group and −12.5 points in the placebo group, with a mean difference in change of −1.9 points (95% CI, −5.0 to 1.1; P=0.21) in the multiple-imputation analysis.

    “The mean (±SD) change in the total OSDI score was −13.9±15.6 points in the active supplement group and −12.5±18.2 points in the placebo group, resulting in a mean difference in change of −1.9 points (95% confidence interval [CI], −5.0 to 1.1; P = 0.21) in an analysis performed with the regression method of multiple imputation for missing data”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Changes in conjunctival staining, corneal staining, tear break-up time, and Schirmer's test result were not significantly different between groups (P≥0.25 for all comparisons).

    “Changes in these signs were not significantly different in the two trial groups (P≥0.25 for all comparisons)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The four prespecified subgroup analyses did not reveal significant interactions (P≥0.29), and within subgroups estimated mean differences in OSDI change did not exceed 3.3 points.

    “The 4 prespecified subgroup analyses did not reveal any significant interactions (P≥0.29 for all comparisons) (Table 3). Within subgroups, the estimated mean differences in change in the OSDI score between trial groups did not exceed 3.3 points.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    OSDI scores decreased between baseline and 12 months in both active and placebo groups (P<0.001 for change in each group), with most decrease during the first 3 months.

    “OSDI scores decreased between baseline and 12 months in the active supplement group and in the placebo group (P<0.001 for change in each group); most of the decrease was during the first 3 months”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The significance of differences between groups for 18 secondary outcomes, adherence measures, and safety measures was evaluated with post hoc Benjamini-Hochberg adjustment.

    “The significance of differences between trial groups for 18 secondary outcomes, measures of adherence to the trial regimen, and safety measures were evaluated with post hoc application of the Benjamini–Hochberg adjustment.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    A sample of 505 patients was determined to provide 90% statistical power to detect a 6-point mean difference between groups in mean change in OSDI score, assuming a standard deviation of 18 points and missing data for 15% of patients.

    “We determined that a sample of 505 patients would provide the trial with 90% statistical power to detect a 6-point mean difference between trial groups in the mean change in the OSDI score, assuming a standard deviation of 18 points and missing data for 15% of patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Propensity scores and the regression method of multiple imputation were used for missing OSDI scores at month 6 or 12.

    “Propensity scores and the regression method of multiple imputation were used for missing OSDI scores at month 6 or 12.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    In the active group, 91.0% at 6 months and 85.2% at 12 months exceeded the EPA threshold for adherence to treatment.

    “In the active supplement group, for 264 of the 290 patients who were assessed at 6 months (91.0%) and for 247 of the 290 patients who were assessed at 12 months (85.2%), the EPA level exceeded the threshold for adherence to treatment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    At 12 months, 83.0% of active-group patients and 82.9% of placebo-group patients reported taking five capsules daily.

    “At 12 months, 269 of 324 patients in the active supplement group (83.0%) and 136 of 164 patients in the placebo group (82.9%) reported taking five capsules daily.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Prespecified subgroups were defined according to baseline severity of symptoms, severity of signs, EPA and DHA levels in red cells, and ocular inflammation.

    “Prespecified subgroups were defined according to baseline severity of symptoms (OSDI score ≥40 vs. <40), severity of signs (severe [conjunctival staining score, ≥2; corneal staining score, ≥4; tear break-up time, <5 seconds; and the result on Schirmer’s test, ≤7 mm in 5 minutes] vs. not severe), EPA and DHA levels in red cells”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The DREAM trial was registered with ClinicalTrials.gov number NCT02128763.

    “(Funded by the National Eye Institute, National Institutes of Health; DREAM ClinicalTrials.gov number, NCT02128763.)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Randomization was performed with a Web-based module and was stratified according to clinical center with a permuted-block method with randomly chosen block sizes.

    “Randomization was performed with the use of a Web-based module and was stratified according to clinical center with a permuted-block method with randomly chosen block sizes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The contents of the active and placebo capsules were verified by an independent laboratory.

    “The contents of the active and placebo capsules were verified by an independent laboratory (Nutra-source Diagnostics).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The mean EPA level increased by 2.2 percentage points in the active group and 0.0 percentage points in the placebo group (P<0.001).

    “The change in the mean EPA level was 2.2 percentage points in the active supplement group as compared with 0.0 percentage points in the placebo group (P<0.001)”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Analyses were performed according to the intention-to-treat principle.

    “Analyses were performed according to the intention-to-treat principle.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The mean DHA level increased by 1.6 percentage points in the active group and decreased by 0.1 percentage points in the placebo group (P<0.001).

    “the change in the mean DHA level was 1.6 percentage points as compared with −0.1 percentage points (P<0.001)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Follow-up visits were completed for 93.3% of scheduled visits in the active group and 89.2% in the placebo group.

    “A total of 974 of the 1044 scheduled follow-up visits (93.3%) were completed in the active supplement group, and 498 of the 558 visits (89.2%) were completed in the placebo group.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All patients, clinical staff, and laboratory personnel were unaware of the trial-group assignments.

    “All patients, clinical staff, and laboratory personnel were unaware of the trial-group assignments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    A total of 349 patients were assigned to active supplement and 186 to placebo; the primary analysis included 329 and 170 patients, respectively.

    “A total of 349 patients were assigned to the active supplement group and 186 to the placebo group; the primary analysis included 329 and 170 patients, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The DREAM trial was a multicenter, double-blind clinical trial.

    “In a multicenter, double-blind clinical trial, we randomly assigned patients with moderate-to-severe dry eye disease to receive a daily oral dose of 3000 mg of fish-derived n–3 eicosapentaenoic and docosahexaenoic acids (active supplement group) or an olive oil placebo (placebo group).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Patients were randomly assigned in a 2:1 ratio to receive active or placebo supplements for 12 months.

    “Patients were randomly assigned, in a 2:1 ratio, to receive active or placebo supplements for 12 months.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Patients were recruited from private and academic optometry and ophthalmology practices throughout the United States and had symptoms and signs of moderate-to-severe dry eye disease on two consecutive examinations 2 weeks apart.

    “Patients were recruited from private and academic optometry and ophthalmology practices throughout the United States and had symptoms and signs of moderate-to-severe dry eye disease on two consecutive examinations that were performed 2 weeks apart.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    The dose of 3000 mg daily n-3 fatty acids was the highest dose used in previous clinical trials of fish-derived n-3 fatty acids.

    “The dose of n–3 fatty acids (3000 mg daily) was the highest dose used in previous clinical trials of fish-derived n–3 fatty acids.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The 1-year follow-up period minimized the effect of seasonal factors.

    “The 1-year follow-up period minimized the effect of seasonal factors.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Patients were allowed to continue their current treatments for dry eye disease.

    “Patients were allowed to continue their current treatments for dry eye disease, which is not the case in most industry-sponsored trials of treatments for this disease.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Eye examinations were conducted according to a standard protocol by trial-certified staff to reduce variation between visits and examiners.

    “Eye examinations were conducted according to a standard protocol by trial-certified staff to reduce variation between visits and examiners.”
    Quote in the paperSubstantial claim
28 of 28

  • The paper relies on this without support.

    The olive oil placebo is neutral with respect to changes in symptoms and signs of dry eye disease.

    “The daily placebo was approximately 1 teaspoon of olive oil, which primarily delivers n–9 oleic acid, a substance that is considered to be neutral with respect to changes in symptoms and signs of dry eye disease.”
1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. 12-Item Ocular Surface Disease Index (OSDI) administration and scoring manual. Irvine CA: Allergan November 2004.

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Related

Authors
The Dry Eye Assessment and Management Study Research Group
Affiliations
University of Pennsylvania (US)
Corresponding author
The Dry Eye Assessment and Management Study Research Group
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2018-05-03
Volume
378
Issue
18
Pages
1681-1690
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1709691
PMC
PMC5952353
OpenAlex
W2887843846
Semantic Scholar
a1beaa20e2b7fe75859e207b7ba0b51a23e84331
Cited by
274
References
25
Citations by year
2026: 26 · 2025: 26 · 2024: 33 · 2023: 34 · 2022: 33 · 2021: 35 · 2020: 36 · 2019: 34 · 2018: 17
FWCI
29.08
Type
journal article
Language
en
Open access
Licence
www.nejmgroup.org/legal/terms-of-use.htm (vor)
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • Office of Dietary Supplements
  • National Eye Institute (U10EY022879, U10EY022881)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ocular Surface and Contact Lens
  • Health Sciences › Nursing › Nutrition and Dietetics › Fatty Acid Research and Health
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
Keywords
dry eye, omega-3 fatty acids, eicosapentaenoic acid, docosahexaenoic acid, fish oil supplementation, Ocular Surface Disease Index, conjunctival staining, corneal staining, tear film break-up time, Schirmer test, ocular surface disease, tear film, subgroup analysis, quality of life
MeSH terms
Olive Oil, Administration, Oral, Adult, Aged, Docosahexaenoic Acids, Double-Blind Method, Female, Humans, Keratoconjunctivitis Sicca, Male, Middle Aged, Severity of Illness Index, Eicosapentaenoic Acid, Treatment Failure, Dietary Supplements

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