GLA supplementation improved patient’s MGD signs, symptoms
Gamma linolenic acid has been recognized for its potent anti-inflammatory properties.
In 2016, Professor Christophe Baudouin and colleagues published a comprehensive paper on meibomian gland dysfunction, calling it, “the most frequent cause of dry eye disease.
“Eyelid inflammation, microbial growth, associated skin disorders as well as potentially severe corneal complications culminate to make MGD a complex multifactorial disorder,” they added.
Managing meibomian gland dysfunction (MGD) can be vexing for clinicians because there is no single ideal therapy. Individuals who suffer from the signs and symptoms of MGD often seek relief by self-treatment with over-the-counter artificial tears.
Preparations that contain lipids may reduce tear osmolarity, improve tear break-up time and give a sense of overall improvement in signs and symptoms. Although these preparations may reduce symptoms, they are often palliative and rarely prevent the progression of MGD.
Heat and gland expression have long been mainstays in management of MGD. Heating sebum to 40°C reduces its viscosity and allows it to be more easily be expressed. In many individuals, firm expression facilitates the removal of keratin plugs that block the meibomian gland orifices and improves the delivery of lipids to the eyelid margins and ocular surface.
An evaluation of MeiboPatch (Visu-Pharma) used daily by patients for 3 months and LipiFlow (TearScience) performed in a single office visit demonstrated the beneficial effects of both therapies (Baumann et al.). After 3 months of treatment with the MeiboPatch, subjects demonstrated an almost twofold increase in the number of functional meibomian glands. Three months after LipiFlow therapy, subjects had almost three times as many functional meibomian glands than before therapy. Significant improvements were also seen in functional scores and overall evaluation of the ocular surface.
Role of inflammation
The critical role that inflammation plays in the pathophysiology of MGD is well established. Omega fatty acids possess anti-inflammatory attributes and have been widely used in treatment.
Dry eye therapy has often focused on the inclusion of omega-3 fatty acids. In the past decade, gamma linolenic acid (GLA), a unique omega-6 fatty acid, has been recognized for its potent anti-inflammatory properties (Brignole-Baudouin et al.) and has been incorporated into HydroEye (ScienceBased Health), a nutraceutical formulation for dry eye.
In a double-masked study, Sheppard and colleagues evaluated the effects of HydroEye vs. placebo in subjects with confirmed dry and reported excellent outcomes.
Below is a case study of an individual with MGD in which heat therapy and nutritional supplements provided relief and halted the progression of disease.
A 59-year-old contact lens wearer presented for evaluation and follow-up care. His ocular health history included chronic dry eye, a single episode of herpes simplex keratitis in the left eye and bilateral MGD. He wore Air Optix Aqua Multifocal contact lenses (Alcon) on a daily wear, monthly replacement schedule. Visual acuities with his contact lenses were 20/25+ OD and 20/40 OS, and the best vision with overall refraction was 20/20- OU. Biomicroscopy revealed bilaterally reduced tear meniscus and grade 2+ MGD. Corneal sensation was intact in the right eye but severely reduced in the left eye. The contact lens surfaces showed significant coating, especially in the left eye.
After reviewing our findings with the patient, we prescribed omega-3 supplementation and daily thermal therapy with the Bruder Moist Heat Eye Compress and we instructed him how to express his meibomian glands after using the heat therapy. He began taking a store-bought fish oil, two 1,000-mg capsules twice a day. Each capsule contained 300 mg of unspecified omega-3 fatty acids.
Two months later, the patient reported minimal improvement in comfort or vision. His acuities were 20/20 OD and 20/25 OS. The omega-3s did help stabilize the tear film, which is likely why his vision improved. The appearance of his tears and meibomian gland secretions was unchanged. We instructed him to continue the thermal therapy and discontinue the fish oil and prescribed him two HydroEye (ScienceBased Health), soft gels orally twice daily, anticipating that the addition of GLA and its anti-inflammatory properties would provide greater improvement.
Four weeks later, the patient reported significant improvements in ocular comfort and vision. Evaluation revealed reduced lens deposits and reduced viscosity of his meibum. He continues his daily regimen of heat therapy combined with HydroEye supplementation.
A controlled clinical trial would have required a “wash-out” period of the original omega-3 supplement prior to beginning the HydroEye formulation. As this was not done, it is conceivable the HydroEye supplement benefited from a primer effect of the previous omega-3 supplement. However, my sense is that the HydroEye formulation was primarily responsible for improved symptoms. One other potential regimen change might have been to discontinue monthly replacement contact lenses with daily disposable lenses.
MGD has been identified as the most common cause of dry eye. This chronic condition results in chronic inflammation, increased intraductal pressure, resultant dilatation and, eventually, acinar atrophy. In addition to heat, expression and other therapies, dietary supplementation with anti-inflammatory omega fatty acids has been identified as a potentially beneficial therapeutic option.
- Baudouin C, et al. Br J Ophthalmol. 2016;bjo.bmj.com/content/100/3/300.
- Baumann A, et al. J Fr Ophtalmol. 2014;doi: 10.1016/j.jfo.2013.12.007.
- Brignole-Baudouin F, et al. Acta Ophthalmologica. 2011;doi: 10.1111/j.1755-3768.2011.02196.x.
- Knop E, et al. Invest Ophthalmol Vis Sci. 2011;doi:10.1167/iovs.10-6997c.
- Machalinska A, et al. Cornea. 2015;34(9):1098-1104.
- Nichols KK, et al. Invest Ophthalmol Vis Sci. 2011;doi:10.1167/iovs.10-6997.
- Sheppard JD, et al. Cornea. 2013;doi: 10.1097/ICO.0b013e318299549c.
- Wang L, et al. Inflammopharmacology. 2016;doi:10.1007/s10787-016-0291-2.
- For more information:
- William D. Townsend, OD, practices with Advanced Eye Care in Canyon, Texas. He is also an adjunct professor of optometry at the University of Houston College of optometry. He can be reached at: email@example.com.
Disclosure: Townsend reports he is a consultant to Alcon and ScienceBased Health.