http://www.lifeextension.com/Magazine/2017/6/Reverse-Dry-Eye-Syndrome/Page-01?utm_source=facebook&utm_medium=social&utm_campaign=normal
By Michael Downey
An estimated 20 million Americans or more suffer from dry eye syndrome.
This condition occurs when the eyes don’t produce enough quality tears. It’s one of the most common eye conditions seen by physicians.1
Dry eye symptoms include burning, stinging, grittiness, tearing, foreign body sensation, ocular fatigue, and dryness. Dry eye syndrome significantly affects quality of life.1,2
Mainstream solutions for dry eyes are limited. Over-the-counter eye drops, or “artificial tears,” provide only short-term relief.3
Restasis®, a prescription drug approved by the FDA specifically for dry eye syndrome, can cause side effects such as burning, itching, stinging, redness, and blurred vision—the very dry eye symptoms you’re trying to eliminate!4
Japanese scientists have found a better alternative. Maqui berry extract is an oral supplement that safely combats dry eyes by boosting the body’s tear production.5,6 As a result, this berry extract can deliver rapid and long-lasting relief for dry, irritated eyes, while also helping to protect the eyes from long-term damage.
Clinical research demonstrates that a single oral capsule daily relieves dry eye syndrome within 30 days and provides lasting relief—without risky prescription-drug eye-drops’ side-effects.6
Tears are absolutely essential for protecting the cornea, the front surface of the eye. In addition to providing lubrication, tears help protect the eyes from infection, wash away foreign matter, and deliver critical nutrients. Because the cornea contains no blood vessels, it relies on the aqueous humor (fluid behind the cornea) and an adequate flow of high-quality tears for delivery of nutrients and infection-fighters.7,8
Tears are important to lubricate and nourish the eye, but when these are of poor quality or not produced in sufficient amounts, it leads to a condition known as keratoconjunctivitis sicca or simply dry eye syndrome.2
Insufficient lubrication of the cornea has two critical consequences: discomfort now and eye damage later.
Today, the stinging, itching, inflammation, light-sensitivity, distraction, and difficulty focusing can reduce quality of life. Studies show that eye irritation can become so disturbing that it can even lower scores on standard mental-health scales.9,10
But over time, what started off as a mild irritation can turn into vision impairment. That’s because tears carry antimicrobial defenses that help prevent eye infections. Reduced production or increased evaporation can result in damage to the cornea and the conjunctiva, which is the layer that lines the eyeball and inner surfaces of the lids.1 Scratches and other injuries to the cornea don’t heal well in the presence of dry eye.11 When the cornea becomes damaged, it can ultimately impair vision.7
This is associated with a variety of risk factors including aging, computers, flat-screen displays, smart phones, contact lenses, vision-correcting and cataract surgeries, and stresses, including stress from ultraviolet exposure.1,13-18
People with dry eyes generally don’t produce enough tears, their tears evaporate too quickly, or, most critically, they have a low quality of tear film.
Tear film contains three layers—oil, water, and mucous.3 The health of the cornea and conjunctiva require all three layers to be of good quality.
The minute quantity of tears produced daily—normally ranging from under 1 mL to just over 3 mL per eye6—needs to lubricate, nourish, and protect the comparatively large surface area of the eye. If the water element (the middle layer) evaporates too rapidly, the remaining tear fluid becomes excessively concentrated,19-21 which in turn impairs many of the tear film’s critical functions.
In addition, having insufficient tears causes inflammation, which then lowers tear production even further, creating a vicious cycle.19
Two of the most common characteristics of dry eye syndrome are the inadequacy of the water layer of tears produced by the lacrimal glands and insufficient oil production from the meibomian glands.22
It’s no wonder artificial tears fall short when it comes to treating dry eye: they can’t replicate the complex structure of real tears.
That’s what makes research into the effects of maqui berry extract on tear production so exciting. Maqui berry extract safely and quickly boosts the body’s own tear production. As a result, it delivers fast, long-lasting relief for dry, irritated eyes—while also helping to protect the eyes from long-term damage.6
Maqui is native to a few regions of Chile and southern Argentina,23,24 and contains compounds that help prevent low-grade injury to the lacrimal glands, enhancing their ability to make tears.5 These compounds are called delphinidins, and they fall into the anthocyanin family of plant extracts that are known to fight oxidative damage.
Delphinidins provide two potent eye-protecting activities. First, they shield the eye structures from the constant exposure to reactive oxygen species. Second, they inhibit damage from light stimulation to the eye’s delicate tissues, such as the photoreceptor cells.25
Animal research has also found that delphinidins in maqui berries can restore tear production by the lacrimal glands.5 For this study, scientists created a rat model of dry eye by suppressing the animals’ blink reflex in order to allow excessive evaporation from the eye surface. One group of rats was pretreated with maqui berry extract, while the other served as the control.
In the end, pretreatment with maqui berry extract significantly prevented the loss of tears that was observed in the control group. Despite the suppressed blink reflex, the animals pretreated with maqui berry extract retained clear eyes with no new corneal damage throughout the study. Untreated controls experienced considerable corneal damage from the extended dry-eye periods.5
They selected 13 healthy volunteers with moderately dry eyes, according to Schirmer’s test—which is a way to assess the amount of fluid produced by the tear glands and whether it is sufficient to keep the eyes moist.30 All participants took either 30 or 60 mg of maqui berry extract daily.6
After 30 days, both doses resulted in an approximately 50% improvement in tear production.
After 60 days, the 60 mg dose proved compellingly more effective for long-term use, delivering a sustained 45% improvement in tear production—while tear production in the 30 mg dose fell around halfway back toward baseline levels.6
This clarified that 60 mg of maqui berry extract daily can help reverse dry eye conditions, which are associated with burning, eye fatigue, sensitivity to light, blurred vision, and other symptoms.6
In 2016, scientists found that dry eye symptoms are greater in diabetics.31
Another recent study showed that pregnancy can reduce tear production.32
In 2016, BMJ Open published research demonstrating that higher blood levels of mercury were significantly associated with dry eye symptoms.33
Over 85% of HIV patients were found to have dry eye symptoms in another 2016 study, which also named radiation, infection, and smoking as potential causes.34
Other identified causes of dry eye symptoms include birth control pills, menopause, breastfeeding, antidepressants, antihistamines, diuretics and blood pressure drugs, decongestants, antianxiety agents, Bell’s palsy, thyroid dysfunction, rheumatoid arthritis, myasthenia gravis, and Sjögren’s syndrome.35
Regardless of the cause, recent studies have discovered that maqui berry extracts and omega-3 fatty acids can help prevent and reverse dry eyes by helping the body naturally maintain both the quantity—and quality—of tears.
All patients completed the standard Dry Eye-Related Quality of Life Score (DEQS) test. This is a reliable questionnaire that consists of 15 items related to the influence of dry-eye syndrome on daily life, including its mental aspect. The overall degree of impairment to quality of life is calculated as a score—with a lower score indicating a greater quality of life.
Both dosing groups had a total composite score—eye and daily-life symptoms—of about 40 at the outset of the study. Scores for both groups fell quickly after treatment with maqui berry extract began. Patients taking 30 mg of maqui berry extract daily experienced a reduction (improvement) to a score of almost 22 (from a baseline of 40) in their scores after 30 days. However, their score didn’t drop much further by day 60.6
The score for patients taking 60 mg of maqui berry extract daily dropped to almost 27 after 30 days. In contrast to the lower (30 mg) dose group, the dry eye score of those taking 60 mg of maqui continued to fall after 60 days to an astoundingly low 11 points. This constitutes a 72% improvement in quality-of-life symptoms after just two months!6
This greater long-term improvement in quality of life for those taking 60 mg daily parallels the longer-lasting boost in tear production with the same dose in the same patients in the other part of the study.6
This study underscores maqui berry extract’s clear superiority to eye drops in improving tear fluid production, eye comfort, and quality of life.
A 2016 study found that omega-3s—when taken for 12 weeks as part of a formula that also provided vitamins, minerals, and antioxidants—reduced a wide range of dry eye symptoms including stinging, conjunctiva redness, scratchiness, blurred vision, and painful and tired eyes. The study author concluded that:
Tear-film breakup time is critical because when it is less than the blinking rate, the eyes suffer intermittent but repeated periods of exposure, producing symptoms of dry eye syndrome and—in addition to the discomfort—potentially injuring the eye.1,37,38
A third study confirmed that omega-3s improve tear-film breakup time and also enhance oily tear secretions, as measured by Schirmer’s test.39
These findings suggest that omega-3 fatty acids support the meibomian glands, which produce the vital lipid layer of the tear film and prevent overly rapid tear evaporation. Omega-3s, therefore, appear to be the perfect complement to maqui berry extract, which supports enhanced production of the aqueous (watery) layer of the tear film.
The following is a list of possible symptoms that can be indicative of dry eye syndrome:40
Dry eye syndrome is an increasingly common condition that causes discomfort and reduced quality of life in the short-term and that can damage eye tissue in the long-term.
A sufficient amount of tears and a healthy quality of the tear film are essential for protecting the cornea from infection and delivering critical nutrients. Damage and inflammation caused by dry eyes leads to further tear reduction, creating a vicious cycle.
A natural, orally-administered extract of the maqui berry has been shown to soothe eyes from the inside out by stimulating healthy tear production and enhancing eye comfort. For additional support, omega-3 fatty acids have been found to help slow tear evaporation from the eye.
Together, these two nutrients help combat the key characteristics of dry eye syndrome.
If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.
This condition occurs when the eyes don’t produce enough quality tears. It’s one of the most common eye conditions seen by physicians.1
Dry eye symptoms include burning, stinging, grittiness, tearing, foreign body sensation, ocular fatigue, and dryness. Dry eye syndrome significantly affects quality of life.1,2
Mainstream solutions for dry eyes are limited. Over-the-counter eye drops, or “artificial tears,” provide only short-term relief.3
Restasis®, a prescription drug approved by the FDA specifically for dry eye syndrome, can cause side effects such as burning, itching, stinging, redness, and blurred vision—the very dry eye symptoms you’re trying to eliminate!4
Japanese scientists have found a better alternative. Maqui berry extract is an oral supplement that safely combats dry eyes by boosting the body’s tear production.5,6 As a result, this berry extract can deliver rapid and long-lasting relief for dry, irritated eyes, while also helping to protect the eyes from long-term damage.
Clinical research demonstrates that a single oral capsule daily relieves dry eye syndrome within 30 days and provides lasting relief—without risky prescription-drug eye-drops’ side-effects.6
Dry Eye Health Risks
Tears are important to lubricate and nourish the eye, but when these are of poor quality or not produced in sufficient amounts, it leads to a condition known as keratoconjunctivitis sicca or simply dry eye syndrome.2
Insufficient lubrication of the cornea has two critical consequences: discomfort now and eye damage later.
Today, the stinging, itching, inflammation, light-sensitivity, distraction, and difficulty focusing can reduce quality of life. Studies show that eye irritation can become so disturbing that it can even lower scores on standard mental-health scales.9,10
But over time, what started off as a mild irritation can turn into vision impairment. That’s because tears carry antimicrobial defenses that help prevent eye infections. Reduced production or increased evaporation can result in damage to the cornea and the conjunctiva, which is the layer that lines the eyeball and inner surfaces of the lids.1 Scratches and other injuries to the cornea don’t heal well in the presence of dry eye.11 When the cornea becomes damaged, it can ultimately impair vision.7
Increased Prevalence of Dry Eye
The prevalence of dry eye syndrome has been rising both in the US and worldwide, especially among women.1,6,12This is associated with a variety of risk factors including aging, computers, flat-screen displays, smart phones, contact lenses, vision-correcting and cataract surgeries, and stresses, including stress from ultraviolet exposure.1,13-18
Quality—Not Just Quantity—of Tears
Dry eye syndrome has a number of potential causes.People with dry eyes generally don’t produce enough tears, their tears evaporate too quickly, or, most critically, they have a low quality of tear film.
Tear film contains three layers—oil, water, and mucous.3 The health of the cornea and conjunctiva require all three layers to be of good quality.
The minute quantity of tears produced daily—normally ranging from under 1 mL to just over 3 mL per eye6—needs to lubricate, nourish, and protect the comparatively large surface area of the eye. If the water element (the middle layer) evaporates too rapidly, the remaining tear fluid becomes excessively concentrated,19-21 which in turn impairs many of the tear film’s critical functions.
In addition, having insufficient tears causes inflammation, which then lowers tear production even further, creating a vicious cycle.19
Two of the most common characteristics of dry eye syndrome are the inadequacy of the water layer of tears produced by the lacrimal glands and insufficient oil production from the meibomian glands.22
It’s no wonder artificial tears fall short when it comes to treating dry eye: they can’t replicate the complex structure of real tears.
That’s what makes research into the effects of maqui berry extract on tear production so exciting. Maqui berry extract safely and quickly boosts the body’s own tear production. As a result, it delivers fast, long-lasting relief for dry, irritated eyes—while also helping to protect the eyes from long-term damage.6
The Three Layers of Lubricating Tear Film
- The outermost or surface layer of tear film is the oil layer and is produced by glands on the edge of your eyelids called the meibomian glands. It prevents overly rapid tear evaporation.26,27
- The middle layer is the water layer and is produced by the lacrimal glands. It is an essential component of tear film.28
- The innermost or bottom layer, directly over the cornea, is the mucin layer. It provides lubrication and protection to the cornea.29
Maqui Berry Extract Protects Eyes and Promotes Tears
Japanese scientists were the first to discover the effects of a standardized extract of maqui berry (Aristotelia chilensis).Maqui is native to a few regions of Chile and southern Argentina,23,24 and contains compounds that help prevent low-grade injury to the lacrimal glands, enhancing their ability to make tears.5 These compounds are called delphinidins, and they fall into the anthocyanin family of plant extracts that are known to fight oxidative damage.
Delphinidins provide two potent eye-protecting activities. First, they shield the eye structures from the constant exposure to reactive oxygen species. Second, they inhibit damage from light stimulation to the eye’s delicate tissues, such as the photoreceptor cells.25
Animal research has also found that delphinidins in maqui berries can restore tear production by the lacrimal glands.5 For this study, scientists created a rat model of dry eye by suppressing the animals’ blink reflex in order to allow excessive evaporation from the eye surface. One group of rats was pretreated with maqui berry extract, while the other served as the control.
In the end, pretreatment with maqui berry extract significantly prevented the loss of tears that was observed in the control group. Despite the suppressed blink reflex, the animals pretreated with maqui berry extract retained clear eyes with no new corneal damage throughout the study. Untreated controls experienced considerable corneal damage from the extended dry-eye periods.5
What You Need to Know
 |
Reversing Dry Eye Syndrome
- Dry eye syndrome—increasingly common and driven by numerous factors in modern life—causes more than discomfort and over time, it can expose the eye to serious damage.
- Too little production of either the watery layer, or the oily layer, of tear film results in too-rapid evaporation of tears.
- Scientists have discovered that a single oral capsule of maqui berry extract taken daily boosts natural, high-quality tear production within 30 days, providing lasting relief and eye protection.
- Omega-3 fatty acids have been shown to support the tear-production benefits of maqui berry extract by slowing tear evaporation from the eyes.
- Taken together, these two nutrients address two of the key underlying characteristics of dry eye syndrome.
Maqui Berry Validated in Human Studies
Next, scientists designed a study to determine whether maqui berry extract could enhance tear production and improve eye comfort in humans suffering from dry eyes.6They selected 13 healthy volunteers with moderately dry eyes, according to Schirmer’s test—which is a way to assess the amount of fluid produced by the tear glands and whether it is sufficient to keep the eyes moist.30 All participants took either 30 or 60 mg of maqui berry extract daily.6
After 30 days, both doses resulted in an approximately 50% improvement in tear production.
After 60 days, the 60 mg dose proved compellingly more effective for long-term use, delivering a sustained 45% improvement in tear production—while tear production in the 30 mg dose fell around halfway back toward baseline levels.6
This clarified that 60 mg of maqui berry extract daily can help reverse dry eye conditions, which are associated with burning, eye fatigue, sensitivity to light, blurred vision, and other symptoms.6
Surprising Causes of Dry Eye Syndrome
 |
Another recent study showed that pregnancy can reduce tear production.32
In 2016, BMJ Open published research demonstrating that higher blood levels of mercury were significantly associated with dry eye symptoms.33
Over 85% of HIV patients were found to have dry eye symptoms in another 2016 study, which also named radiation, infection, and smoking as potential causes.34
Other identified causes of dry eye symptoms include birth control pills, menopause, breastfeeding, antidepressants, antihistamines, diuretics and blood pressure drugs, decongestants, antianxiety agents, Bell’s palsy, thyroid dysfunction, rheumatoid arthritis, myasthenia gravis, and Sjögren’s syndrome.35
Regardless of the cause, recent studies have discovered that maqui berry extracts and omega-3 fatty acids can help prevent and reverse dry eyes by helping the body naturally maintain both the quantity—and quality—of tears.
Quality-of-Life Improvements
Using the same subjects, the study team conducted quality-of-life measurements.All patients completed the standard Dry Eye-Related Quality of Life Score (DEQS) test. This is a reliable questionnaire that consists of 15 items related to the influence of dry-eye syndrome on daily life, including its mental aspect. The overall degree of impairment to quality of life is calculated as a score—with a lower score indicating a greater quality of life.
Both dosing groups had a total composite score—eye and daily-life symptoms—of about 40 at the outset of the study. Scores for both groups fell quickly after treatment with maqui berry extract began. Patients taking 30 mg of maqui berry extract daily experienced a reduction (improvement) to a score of almost 22 (from a baseline of 40) in their scores after 30 days. However, their score didn’t drop much further by day 60.6
The score for patients taking 60 mg of maqui berry extract daily dropped to almost 27 after 30 days. In contrast to the lower (30 mg) dose group, the dry eye score of those taking 60 mg of maqui continued to fall after 60 days to an astoundingly low 11 points. This constitutes a 72% improvement in quality-of-life symptoms after just two months!6
This greater long-term improvement in quality of life for those taking 60 mg daily parallels the longer-lasting boost in tear production with the same dose in the same patients in the other part of the study.6
This study underscores maqui berry extract’s clear superiority to eye drops in improving tear fluid production, eye comfort, and quality of life.
Additional Support with Omega-3s
Recent evidence demonstrates that supplementation with omega-3 fatty acids can also help improve dry eye symptoms. Different from maqui berry extracts, which increase the body’s production of tears, omega-3s help combat dry eyes by slowing tear evaporation from the eyes.A 2016 study found that omega-3s—when taken for 12 weeks as part of a formula that also provided vitamins, minerals, and antioxidants—reduced a wide range of dry eye symptoms including stinging, conjunctiva redness, scratchiness, blurred vision, and painful and tired eyes. The study author concluded that:
“Oral omega-3 fatty acids supplementation was an effective treatment for dry eye symptoms.”36In another study on omega-3s by themselves, patients with dry eye syndrome took 500 mg of omega-3 fatty acids (325 mg EPA and 175 mg DHA) twice a day for three months. Compared to a placebo, the supplemented patients demonstrated on average a nearly 20-fold increase in tear-film breakup time (the time it takes for tears to disperse) and a more than 4-fold improvement in symptom scores.37
Tear-film breakup time is critical because when it is less than the blinking rate, the eyes suffer intermittent but repeated periods of exposure, producing symptoms of dry eye syndrome and—in addition to the discomfort—potentially injuring the eye.1,37,38
A third study confirmed that omega-3s improve tear-film breakup time and also enhance oily tear secretions, as measured by Schirmer’s test.39
These findings suggest that omega-3 fatty acids support the meibomian glands, which produce the vital lipid layer of the tear film and prevent overly rapid tear evaporation. Omega-3s, therefore, appear to be the perfect complement to maqui berry extract, which supports enhanced production of the aqueous (watery) layer of the tear film.
Are Your Eyes Dangerously Dry?
 |
- Eye redness
- Stinging
- Burning
- “Foreign body” sensation
- Blurred vision
- “Eyelid heaviness” sensation
- Eye fatigue
- Feeling of being distracted by eye dryness and fatigue
- Difficulty reading, and,
- Episodes of excess tears following very dry eye periods.
Summary
A sufficient amount of tears and a healthy quality of the tear film are essential for protecting the cornea from infection and delivering critical nutrients. Damage and inflammation caused by dry eyes leads to further tear reduction, creating a vicious cycle.
A natural, orally-administered extract of the maqui berry has been shown to soothe eyes from the inside out by stimulating healthy tear production and enhancing eye comfort. For additional support, omega-3 fatty acids have been found to help slow tear evaporation from the eye.
Together, these two nutrients help combat the key characteristics of dry eye syndrome.
If you have any questions on the scientific content of this article, please call a Life Extension® Wellness Specialist at 1-866-864-3027.
References
- Gayton JL. Etiology, prevalence, and treatment of dry eye disease. Clin Ophthalmol. 2009;3:405-12.
- Available at: http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/dry-eye?sso=y. Accessed March 6, 2017.
- Moon SW, Hwang JH, Chung SH, et al. The impact of artificial tears containing hydroxypropyl guar on mucous layer. Cornea. 2010;29(12):1430-5.
- Available at: https://www.drugs.com/sfx/restasis-side-effects.html. Accessed March 6, 2017.
- Nakamura S, Tanaka J, Imada T, et al. Delphinidin 3,5-O-diglucoside, a constituent of the maqui berry (Aristotelia chilensis) anthocyanin, restores tear secretion in a rat dry eye model. Journal of Functional Foods. 2014;10:346-54.
- Hitoe S, Tanaka J, Shimoda H. MaquiBright standardized maqui berry extract significantly increases tear fluid production and ameliorates dry eye-related symptoms in a clinical pilot trial. Panminerva Med. 2014;56(3 Suppl 1):1-6.
- Available at: https://nei.nih.gov/health/cornealdisease. Accessed March 6, 2017.
- Available at: https://nihseniorhealth.gov/dryeye/whatisdryeye/01.html. Accessed March 6, 2017.
- Tounaka K, Yuki K, Kouyama K, et al. Dry eye disease is associated with deterioration of mental health in male Japanese university staff. Tohoku J Exp Med. 2014;233(3):215-20.
- Le Q, Zhou X, Ge L, et al. Impact of dry eye syndrome on vision-related quality of life in a non-clinic-based general population. BMC Ophthalmol. 2012;12:22.
- Cho YK, Archer B, Ambati BK. Dry eye predisposes to corneal neovascularization and lymphangiogenesis after corneal injury in a murine model. Cornea. 2014;33(6):621-7.
- Available at: https://www.aao.org/newsroom/eye-health-statistics. Accessed March 6, 2017.
- Parihar JK, Jain VK, Chaturvedi P, et al. Computer and visual display terminals (VDT) vision syndrome (CVDTS). Med J Armed Forces India. 2016;72(3):270-6.
- Porcar E, Pons AM, Lorente A. Visual and ocular effects from the use of flat-panel displays. Int J Ophthalmol. 2016;9(6):881-5.
- Yazici A, Sari ES, Sahin G, et al. Change in tear film characteristics in visual display terminal users. Eur J Ophthalmol. 2015;25(2):85-9.
- Azuma M, Yabuta C, Fraunfelder FW, et al. Dry eye in LASIK patients. BMC Res Notes. 2014;7:420.
- Bron AJ, Tomlinson A, Foulks GN, et al. Rethinking dry eye disease: a perspective on clinical implications. Ocul Surf. 2014;12(2 Suppl):S1-31.
- Foulks GN. Pharmacological management of dry eye in the elderly patient. Drugs Aging. 2008;25(2):105-18.
- Yagci A, Gurdal C. The role and treatment of inflammation in dry eye disease. Int Ophthalmol. 2014;34(6):1291-301.
- Garcia-Resua C, Pena-Verdeal H, Remeseiro B, et al. Correlation between tear osmolarity and tear meniscus. Optom Vis Sci. 2014;91(12):1419-29.
- McCulley JP, Uchiyama E, Aronowicz JD, et al. Impact of evaporation on aqueous tear loss. Trans Am Ophthalmol Soc. 2006;104:121-8.
- Horwath-Winter J, Schmut O, Haller-Schober EM, et al. Iodide iontophoresis as a treatment for dry eye syndrome. Br J Ophthalmol. 2005;89(1):40-4.
- Available at: https://plantsforhumanhealth.ncsu.edu/healthy-living/maqui-berry-2/. Accessed March 7, 2017.
- Suwalsky M, Vargas P, Avello M, et al. Human erythrocytes are affected in vitro by flavonoids of Aristotelia chilensis (Maqui) leaves. Int J Pharm. 2008;363(1-2):85-90.
- Tanaka J, Kadekaru T, Ogawa K, et al. Maqui berry (Aristotelia chilensis) and the constituent delphinidin glycoside inhibit photoreceptor cell death induced by visible light. Food Chem. 2013;139(1-4):129-37.
- Benitez-Del-Castillo JM. How to promote and preserve eyelid health. Clin Ophthalmol. 2012;6:1689-98.
- Knop E, Knop N, Schirra F. Meibomian glands. Part II: physiology, characteristics, distribution and function of meibomian oil. Ophthalmologe. 2009;106(10):884-92.
- Walcott B. The Lacrimal Gland and Its Veil of Tears. News Physiol Sci. 1998;13:97-103.
- Schnetler R, Gillan W, Koorsen G. Lipid composition of human meibum: a review. S Afr Optom. 2013;72(2):86-93.
- Available at: https://www.hopkinssjogrens.org/disease-information/diagnosis-sjogrens-syndrome/schirmers-test/. Accessed March 7, 2017.
- Aljarousha M, Badarudin NE, Che Azemin MZ. Comparison of Dry Eye Parameters between Diabetics and Non-Diabetics in District of Kuantan, Pahang. Malays J Med Sci. 2016;23(3):72-7.
- Ibraheem WA, Ibraheem AB, Tjani AM, et al. Tear Film Functions and Intraocular Pressure Changes in Pregnancy. Afr J Reprod Health. 2015;19(4):118-22.
- Chung SH, Myong JP. Are higher blood mercury levels associated with dry eye symptoms in adult Koreans? A population-based cross-sectional study. BMJ Open. 2016;6(4):e010985.
- Conrady CD, Joos ZP, Patel BC. Review: The Lacrimal Gland and Its Role in Dry Eye. J Ophthalmol. 2016;2016:7542929.
- Available at: http://www.health.harvard.edu/diseases-and-conditions/dry-eye-syndrome. Accessed March 7, 2017.
- Gatell-Tortajada J. Oral supplementation with a nutraceutical formulation containing omega-3 fatty acids, vitamins, minerals, and antioxidants in a large series of patients with dry eye symptoms: results of a prospective study. Clin Interv Aging. 2016;11:571-8.
- Bhargava R, Kumar P, Kumar M, et al. A randomized controlled trial of omega-3 fatty acids in dry eye syndrome. Int J Ophthalmol. 2013;6(6):811-6.
- Su TY, Chang SW, Yang CJ, et al. Direct observation and validation of fluorescein tear film break-up patterns by using a dual thermal-fluorescent imaging system. Biomed Opt Express. 2014;5(8):2614-9.
- Liu A, Ji J. Omega-3 essential fatty acids therapy for dry eye syndrome: a meta-analysis of randomized controlled studies. Med Sci Monit. 2014;20:1583-9.
- Available at: https://nei.nih.gov/health/dryeye/dryeye. Accessed March 7, 2017.
