CLINICAL SCIENCE Oral Omega-3 Fatty Acid Treatment for Dry Eye in Contact Lens Wearers Rahul Bhargava, MS,* and Prachi Kumar, MD† Purpose: The aim of this study was to evaluate the effect of dietary omega-3 fatty acid (O3FA) supplementation on dry eye symptoms, tear film tests, and conjunctival impression cytology in patients with contact lens wear–associated dry eye. Methods: In this randomized, double-blind, multicentric trial, contact lens wearers (n = 496) were randomized to receive either O3FAs or placebo capsules (corn oil) twice daily for 6 months. Subjects underwent examinations at baseline, 3 months, and 6 months. At each visit, a questionnaire of dry eye symptoms and lens wear comfort was administered. Subjects further underwent measurement of tear film break-up time (TBUT) and a Schirmer test. Conjunctival impression cytology was performed by the transfer method. Improve- ment in symptoms and lens wear comfort were primary outcome measures. Changes from baseline in TBUT, Schirmer, and Nelson grade at 6 months were secondary outcome measures. Results: The mean improvement in symptom score in the O3FA group was 4.7 6 2 (2.0) as compared with 0.5 6 2 (0.9) in the placebo group (P , 0.0001). Lens wear comfort levels improved significantly (P , 0.0001) from baseline. There was a significant increase in TBUT [3.3 6 2 (1.5)] and Nelson grade [0.7 6 2 (0.6)] in the O3FA group (P , 0.0001) as compared with 0.3 6 2 (0.6) and 0.1 6 2 (0.4) in the placebo group (P = 0.164 and 0.094, respectively). However, the magnitude of increase in Schirmer score [2.0 6 2 (1.5)] was relatively small (P = 0.08). Conclusions: The results of this study point toward benefits of orally administered O3FAs in alleviating dry eye symptoms, improving lens wear comfort, and cytological changes in contact lens wearers. Key Words: contact lens, conjunctival impression cytology, dry eye syndrome, omega-3 fatty acids (Cornea 2015;0:1–8) C ontact lenses on the ocular surface are in proximity to the eyelid margin and tarsal conjunctiva on the front side and to the corneal epithelium, limbus, and bulbar conjunctiva on the back side, being separated by a pre- or post-lens tear film, respectively. Prolonged presence of a contact lens on the anterior corneal surface reduces the thickness of the prelens lipid layer and increases the tear evaporation rate. 1,2 Dryness of eyes is quite frequent in contact lens users; it may be accompanied by ocular discomfort, dissatisfaction, and inability to wear a contact lens for a desired period. 3 Moreover, prolonged lens wear may lead to a decrease in conjunctival goblet cells and squamous metaplasia of conjunctival epithelial cells. 4–8 Various factors such as lens material, lens water content, concurrent use of visual display terminals, ambient humidity conditions, and lens wear time may influence these changes on the ocular surface. Thus, it may be a reasonable assumption that contact lens–related problems are reflective of the overall conjunctival health. Conjunctival surface health may be assessed by con- junctival impression cytology (CIC), which allows cells to be harvested from the ocular surface noninvasively. CIC may detect early subtle changes undetected by routine tear function tests; many investigators are of the opinion that it can be the first-line diagnostic investigation for ocular surface disorders, and an outcome measure in clinical trials. 9,10 O3FAs found in certain fish oils have been shown to be beneficial in other ocular conditions such as age-related macular degeneration in evidence-based studies. 11 However, safety and efficacy of O3FAs in contact lens wear–related dry eye have not been documented. This study hypothesizes that oral O3FA supplementation does improve dry eye symptoms, lens wear comfort, goblet cell density (GCD), and epithelial cell morphology (as seen on CIC) and clinical markers such as Schirmer-1 test values and tear film break-up time (TBUT) in contact lens wearers, as compared with the administration of placebo (corn oil). METHODS A prospective, multicentric, randomized, double-blind interventional study was performed at 3 referral eye centers, in the Northern part of the Indian subcontinent. The trial was approved by the institutional review boards and the local ethics committee. Written informed consent was obtained from all patients willing to participate in the study based on the Helsinki protocol. Inclusion Criteria A survey was conducted in regional universities, medical schools, and information technology parks. Female contact lens users experiencing dry eye symptoms and lens Received for publication August 25, 2014; revision received December 26, 2014; accepted December 30, 2014. From the *Laser Eye Clinic, Noida, India; and †Department of Pathology, Santosh Medical College, Ghaziabad, India. The authors have no funding or conflicts of interest to disclose. Reprints: Rahul Bhargava, MS, B2-004, Ananda Apartments, Sector-48, Noida, UP 201301, India (e-mail: brahul_2371@yahoo.co.in). 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