Multivitamins and Polyunsaturated Fatty Acids in the Treatment of Dry Eye Syndrome

Dry eye syndrome is a global problem of the modern world. Overload of information, rapid urbanization, and a busy lifestyle lead to non-compliance with work and rest schedules, including increased visual loads, decreased stress resistance in conditions of time deficit, leading to a deficiency of vital substances in the body. All the above are risk factors for the development of dry eye syndrome and affect the course of this disease. It is a well-known fact that balanced nutrition, regular intake of vitamins and microelements with food, and compliance with work and rest schedules play a role in the prevention and elimination of clinical manifestations of these conditions. This article presents the results of using the biologically active food supplement “DOPPELHERZ® V.I.P. OFTALMOVIT No. 30” (manufacturer Queisser Pharma GmbH & Co. KG, Germany) in the treatment of dry eye syndrome.

 The purpose of the study: to evaluate the effect of the dietary supplement “DOPPELHERZ® V.I.P. OFTALMOVIT no. 30” in the treatment of dry eye syndrome.

 Material and methods. The study included 90 students with dry eye syndrome, aged 18 to 26 years. Patients of group I (control) did not receive any dietary supplements; group II (study group) received the dietary supplement “DOPPELHERZ® V.I.P. OFTALMOVIT”. 

Results. OSDI questionnaire — in the study group, the severity of dry eye syndrome: “before” moderate n = 38, severe n = 22, “1 month” moderate n = 43, severe n = 17, “2 months” mild n = 11, moderate n = 43, severe n = 6, in the control group no changes (p = 0.368). Norn’s test: the study group showed an increase in tear film breakup time (p < 0.001), no changes were recorded in the control group (p = 0.285). Lacrimal meniscus height: the study group showed an increase in the height of the lacrimal meniscus, which indicates an improvement in the functional properties of the tear film and a decrease in dry eye syndrome (p < 0.001), no changes were recorded in the control group (p = 0.105). Schirmer tests 1 and 2: the study group showed an increase in the tear film breakup time, which indicates an improvement in the functional properties of the tear film and a decrease in dry eye syndrome, no changes were recorded in the control group (RSH1 = 0.587, RSH2 = 0.293). CISS questionnaire: a gradual decrease in the severity of asthenopia signs was observed in the study group (p < 0.001), no changes were recorded in the control group (p = 0.125). Pupillography: in the study group, regression of accommodation tension was recorded, more pronounced after 2 months (p < 0.001), in the control group there was a change in accommodation tension, which can be associated with the alternating predominance of sympathetic and parasympathetic wagging (p < 0.05). 

Discussion. The concept of dry eye syndrome treatment includes etiopathogenetic, non-specific and symptomatic therapy. An integral link in the strategy of pathogenetic treatment of dry eye syndrome is the targeted introduction of vitamins and microelements into the diet. 

Conclusion. Based on the results of the study, as well as on the data of foreign and domestic authors, dietary supplements can serve as an additional source of vitamins and microelements, the deficiency of which is one of the components of the causes of dry eye syndrome pathogenesis. Considering the above, we can recommend taking the dietary supplement “DOPPELHERTS^® V.I.P. OFTALMOVIT” 1 capsule once a day for 2 months in the complex therapy of patients with dry eye syndrome.

1. Proskurina OV, Tarutta EP, Iomdina EN, Strakhov VV, Brezhsky VV. A modern classification of asthenopias: clinical forms and stages. Russian Ophthalmological Journal. 2016;9(4):69–73 (In Russ.). doi: 10.21516/2072-0076-2016-9-4-69-73.

2. Tatarnikova EB, Krivosheina OI. Current treatment modalities for dry eye disease. Russian Journal of Clinical Ophthalmology. 2021;21(1):18–23 (In Russ.). doi: 10.32364/2311-7729-2021-21-1-18-23.

3. Brzheskiy VV, Popov VYu, Kalinina IV. Efficacy of 0.01% Dexamethasone solution in comprehensive therapy Of Dry eye Disease. Ophthalmology journal 2019;12(3):75–82 (In Russ.). doi: 10.17816/OV9332-44.

4. Riks IA. Cyclosporine use in“dryeye” syndrome. Ophthalmologyjournal 2019;12(3): 75–82 (In Russ.). doi: 10.17816/OV15853.

5. De Paiva CS, Pflugfelder SC, Ng SM, Akpek EK. Topical cyclosporine A therapy for dry eye syndrome. Cochrane Database Syst Rev. 2019 Sep 13;9(9):CD010051. doi: 10.1002/14651858.CD010051.pub2.

6. Egorov EA. Features of dry eye syndrome treatment. Clinical ophthalmology. 2018;3:146–149 (In Russ.). doi: 10.21689/2311-7729-2018-18-3-146-149.

7. Tao T, Tao L. Systematic review and meta-analysis of treating meibomian gland dysfunction with azithromycin. Eye (Lond). 2020;34(10):1797–1808. doi: 10.1038/s41433-020-0876-2.

8. Wang L, Cao K, Wei Z. Autologous serum eye drops versus artificial tear drops for dry eye disease: a systematic review and meta-analysis of randomized controlled trials. Ophthalmic Res. 2020;63(5):443–451. doi: 10.1159/000505630.24.

9. Alio JL, Rodriguez AE., Ferreira-Oliveira R. Treatment of Dry Eye Disease with Autologous Platelet-Rich Plasma: A Prospective, Interventional, Non-Randomized Study. 2017;6(2):285–293. doi: 10.1007/s40123-017-0100-z.

10. McDonald MB, Sheha H, Tighe S. Treatment outcomes in the Dry Eye Amniotic Membrane (DREAM) study. Clin Ophthalmol. 2018;9(12):677–681. doi: 10.2147/OPTH.S162203.

11. Shigeyasu C, Hirano S, Akune Y, Yamada M. Diquafosol tetrasodium increases the concentration of mucin-like substances in tears of healthy human subjects. Current eye research. 2015;40(9):878–883. doi: 10.3109/02713683.2014.967871.2.

12. Schröder A, Abrar DB, Hampel U. In vitro effects of sex hormones in human meibomian gland epithelial cells. Exp Eye Res. 2016;151:190–202. doi: 10.1016/j. exer.2016.08.009.

13. Farhangi M, Cheng AM, Baksh B. Effect of non-invasive intranasal neurostimulation on tear volume, dryness and ocular pain. Br J Ophthalmol. 2019 Dec 12. pii: bjophthalmol-2019–315065. doi: 10.1136/bjophthalmol-2019-315065.

14. Kossler AL, Brinton M, Patel ZM. Chronic Electrical Stimulation for Tear Secretion: Lacrimal vs. anterior ethmoid nerve. Ocul Surf. 2019;17(4):822–827. doi: 10.1016/j.jtos.2019.08.012.

15. Honkanen R, Huang W, Huang L. A New Rabbit Model of Chronic Dry Eye Disease Induced by Complete Surgical Dacryoadenectomy. Curr Eye Res. 2019;44(8):863– 872. doi: 10.1080/02713683.2019.1594933.

16. Su JZ, Zheng В, Liu XJ. Quality of Life and Patient Satisfaction Aft r Submandibular Gland Transplantation in Patients With Severe Dry Eye Disease. Ocul Surf. 2019;17(3):470–475. doi: 10.1016/j.jtos.2019.04.007.

17. Kobashi H, Kamiya K, Sambe T, Nakagawa R. Factors influencing subjective symptoms in dry eye disease. Int J Ophthalmol. 2018;18;11(12):1926–1931. doi: 10.18240/ijo.2018.12.08.

18. Molina-Leyva I, Molina-Leyva AO, Bueno-Cavanillas А. Efficacy of dietary supplements with omega-3 and omega-6 fatty acids in dry eye syndrome: a systematic review of clinical trials. Novoye v oftal’mologii. 2019;1:56–60.

19. Belyaeva ES, Sakhovskaya NA, Frolov MA, Gavrilenko TI. Polyunsaturated Fatty Acids in Ophthalmology. Effective pharmacotherapy. 2023;19(46):34–36 (In Russ.). doi: 10.33978/2307-3586-2023-19-46-34-36.

20. Belyaeva ES, Sakhovskaya NA, Frolov MA, The Influence of Vitamins and Microelements on the Organ of Vision. Effective pharmacotherapy. 2024;20(47):36–38 (In Russ.). doi: 10.33978/2307-3586-2024-20-47-36-38.

21. Th Dry Eye Assessment and Management Study Research Grouр. N−3 Fatty Acid Supplementation for the Treatment of Dry Eye Disease. N Engl J Med. 2018;378:1681– 1690. doi: 10.1056/NEJMoa1709691.

22. Prozorny AA, Krivoshein AE, Rusanovsky VV. The use of omega-3 and omega-6 fatty acid preparations in the treatment of dry eye syndrome. Proceedings of the All-Russian Student Scientific Forum with International Participation “Student Science — 2021”. 2021;4(S1):913 (In Russ.).

23. Brzhesky VV, Golubev SYu, Lebedev OI, Milyudin ES, Apostolova AS, Surov AV, Efimova EL, Varlashina EV, Gorbachevskaya IN, Kirichenko VO. New possibilities of complex therapy of patients with dry eye syndrome of various etiologies. Ophthalmology. Eastern Europe. 2022;12(1):151–163 (In Russ.).

24. Patel S, Murray D, McKenzie A, Shearer DS, McGrath BD. Effects of fluorescein on tear break-up time and on tear timing time. Am J Optom and Physiol, 1985; 62(3):188–190. doi: 10.1097/00006324-198503000-00006.

25. Weiss J, Mailer J, Davis Y. Basics of contact vision correction. Evaluation of the tear film. Reprint of the publication: Modern Optometry. 2013;8:14–21 (In Russ.).

26. Tiffany JM. Composition and biophysical properties of the tear film: knowledge and uncertainty. Adv Exp Med Biol. 1994;350:231–238. doi: 10.1007/978-1-4615-24175_40.

27. Guillon JP. Tear film structure and contact lenses. In: Holly FJ (Ed) The Preocular Tear Film in Health, Disease and Con tact Lens Wear. 1986;85:815–939. (Lubbock, Texas: Dry Eye Institute).

28. Egorova EYu, Yudina NV, Gromova OA. The efficiency of combined micronutrients correcting therapy with preparation Focus. Case report. Ophthalmology In Russia. 2011;8(3):57–61 (In Russ.).

29. Zakharova MA, Kuroedov AV. Use of antioxidants in complex therapy of computer vision syndrome. RMJ. Clinical ophthalmology. 2016;16(1):54–59 (In Russ.).

30. Frolov MA, Sakhovskaya NA, Kazakova KA, Luchin VS, Gavrilenko TI. Results of the use of biologically active food additives in children with chronic asthenia and asthenopia. Medical advice. 2024;18(11):145–154 (In Russ.). doi: 10.21518/ms2024-263.

31. Sakhovskaya NA, Frolov MA, Kazakova KA, Kolodkina MG. History of the development of pupillography and the possibility of its application in modern ophthalmology. Ophthalmology In Russia. 2022;19(3):475–481 (In Russ.). doi: 10.18008/1816-50952022-3-475-481.