Modulating contact lens discomfort with anti-inflammatory approaches: A randomized controlled trial

Abstract

PURPOSE. To assess the efficacy of anti-inflammatory approaches, comprising a topical corticosteroid and omega-3 supplements, for modulating the inflammatory overlay associated with contact lens discomfort (CLD). METHODS. This randomized controlled trial involved 72 adults with CLD, randomized (1:1:1:1) to one of the following: placebo (oral olive oil), oral fish oil (900 mg/d eicosapentaenoic acid [EPA] þ 600 mg/d docosohexaenoic acid [DHA]), oral combined fishþflaxseed oils (900 mg/ dEPAþ 600 mg/d DHA þ 900 mg/d alpha-linolenic acid), or omega-3 eye-drops (0.025% EPA þ 0.0025% DHA four times per day [qid]) for 12 weeks, with visits at baseline, weeks 4 and 12. At week 12, participants who received placebo were assigned a low-potency corticosteroid (fluorometholone [FML] 0.1%, drops, three times per day [tid]) for 2 weeks (week 14). RESULTS. Sixty-five participants completed the primary endpoint. At week 12, contact lens dry-eye questionnaire (CLDEQ-8) score was reduced from baseline with oral fish oil (7.3 6 0.8 units, n = 17, P < 0.05), compared with placebo (3.5 6 0.9 units, n = 16). FML produced significant reductions in tear IL-17A (71.1 6 14.3%, n = 12) and IL-6 (47.6 6 17.5%, n = 12, P < 0.05) relative to its baseline (week 12). At week 12, tear IL-17A levels were reduced from baseline in the oral fish oil (63.2 6 12.8%, n = 12, P < 0.05) and topical omega-3 (76.2 6 10.8%, n = 10, P < 0.05) groups, compared with placebo (3.8 6 12.7%, n = 12). Tear IL-6 was reduced with all omega-3 interventions, relative to placebo (P < 0.05) at week 12. CONCLUSIONS. CLD was attenuated by oral long-chain omega-3 supplementation for 12 weeks. Acute (2 week) topical corticosteroids and longer-term (12 week) omega-3 supplementation reduced tear levels of the proinflammatory cytokines IL-17A and IL-6, demonstrating parallels in modulating ocular inflammation with these approaches.