Fish Oil for Dry Eyes: Four DREAM Trial Checks

Who participated?

DREAM randomized 535 adults with moderate-to-severe dry eye; existing treatments could continue. Atrial fibrillation and anticoagulant use were exclusions.¹²

What did capsules contain?

For twelve months, five daily capsules supplied 2,000 mg EPA plus 1,000 mg DHA, or 5,000 mg refined olive oil. NIH funded the study; manufacturers donated products.¹

EPA and DHA are two omega-3 fatty acids. Fish oil, flaxseed oil and cod liver oil have different compositions; cod liver oil also supplies vitamins A and D. A bottle’s total oil weight does not necessarily equal its EPA-plus-DHA content.³

What did scores show?

The fish-oil-minus-olive-oil Ocular Surface Disease Index difference was −1.9 points (95% confidence interval −5.0 to 1.1), not statistically significant. Lower scores mean fewer symptoms. Tear-test changes also did not differ significantly. The endpoint averaged six and twelve months; missing scores were imputed. Observed primary data covered 499 participants. Both improved; this establishes neither oil’s efficacy nor equivalence.¹

The National Center for Complementary and Integrative Health describes the wider dry-eye supplement evidence as inconsistent and insufficient for firm conclusions.⁴

What comes next?

Review the actual supplement label and medication list with your pharmacist or clinician. NIH’s Office of Dietary Supplements notes possible medication interactions, including with anticoagulants. Trials using 4 grams daily for several years found increased atrial-fibrillation risk in people with cardiovascular disease or elevated cardiovascular risk; that population, dose and duration differ from DREAM. Diarrhea can occur.³

The National Eye Institute describes artificial tears for mild dry eye and prescription drops or tear-duct plugs for more serious disease. An eye examination can check the diagnosis; treatment also depends on contributing medicines and other conditions.⁵

For help choosing and using drops, see our artificial-tear and recall guide.

My Body Changed. Now What? discusses the “Supplement Shelf” in its hot-flash chapter, including why improvement after taking a supplement can be difficult to interpret. That discussion concerns menopause symptoms; it is not a dry-eye treatment chapter.