June 2008

 

OPHTHALMOLOGY NEWS

 

A teaspoon a day could help BKC away


by Matt Young EyeWorld Contributing Editor

   
Flaxseed oil may work to counteract dry eye after LASIK; it also could work as a good adjunctive treatment for blepharokeratoconjunctivitis Source: Colin C.K. Chan, M.D.

Daily dose of flaxseed oil studied in children with blepharkeratoconjunctivits

Flaxseed oil could be a good adjunctive treatment for blepharokeratoconjunctivitis (BKC), according to new research. “Flaxseed oil may be an effective antiinflammatory nutritional therapy alternative to long-term antibiotics,” according to Ken K. Nischal, FRCOphth., Visual Sciences Unit, Institute of Child Health, London, co-author of the study, published in the December 2007 issue of Ophthalmology. In a study of 27 children with BKC, 12 (44%) received flaxseed oil as part of their tapering regimen. The dose of flaxseed oil was 2.5 ml (1 teaspoonful) daily. This was reduced to alternate days for six months maximum. “Capsules were not used because the dose contained in these was believed to be too large for children,” Dr. Nischal wrote. After their initial treatment, all 12 patients on flaxseed oil and artificial tears remained stable.

Understanding the supplement

Flaxseed oil was not used as the primary treatment. “It was used only as a maintenance treatment after lid margin disease was controlled,” Dr. Nischal wrote. Primary treatment consisted of modified lid hygiene, topical antibiotics, and steroids. Systemic oral antibiotics also were administered. Best-corrected visual acuity improved in 70% of affected eyes by the last visit and remained unchanged in 30%. Those patients who failed to achieve a visual acuity of 0.2 logMAR units or better at final examination had bilateral corneal involvement when they presented. “One child experienced a systemic side effect from oral antibiotics,” Dr. Nischal noted. But no side effects were reported with flaxseed oil. “Flaxseed oil … a dietary source of omega-3 essential fatty acid (EFA), is a promising new addition in the management of blepharitis,” Dr. Nischal wrote. Already, researchers have reported the benefits of flaxseed oil in rheumatoid arthritis, cardiovascular disease, and inflammatory bowel disease. “By virtue of their effects on the inflammatory and coagulation cascade, omega-3 EFAs possess scientifically proven benefits in numerous nonophthalmic disorders,” Dr. Nischal wrote. He also suggested flaxseed oil could be an effective anti-inflammatory agent, which clearly could be helpful with regard to BKC. “Omega-3 EFAs also provide an anti-inflammatory action by producing anti-inflammatory prostaglandin E3 and anti-inflammatory leukotriene B5,” Dr. Nischal noted. Still, Dr. Nischal added that long-term use of flaxseed oil in children is not well researched, and further study is warranted. This study appears to be a good first step, although still a small one because specific data about how flaxseed oil affected outcomes—especially compared with other agents—has not been published. “To the authors’ knowledge, no study has been published comparing flaxseed oil with oral antibiotics, and its use in pediatric ophthalmology has yet to be evaluated by the Food and Drug Administration,” Dr. Nischal noted. “Therefore, at present it is best to consider this nonprescriptive therapy as an anti-inflammatory nutritional alternative to systemic antibiotics in management of BKC until such a study is published. The lowest possible dose of topical steroid was used, and fluorometholone, a fluorinated steroid that has limited corneal penetration, was used whenever possible.”

The study also was reportedly the largest series outlining visual morbidity in children with blepharitis-related keratitis. Children did experience severe corneal problems, but all patients showed clinical improvement after treatment. In no patients did keratitis worsen with treatment. “In the authors’ experience, effective treatment for BKC should include a combination of both systemic and topical antimicrobial therapy, along with topical steroids,” with flaxseed oil a potential supplement to treatment, Dr. Nischal concluded. Dr. Nischal also suggested that a proper diagnosis of BKC as early as possible is critical. “Diagnosis of BKC should be suspected in all children with symptoms of chronic ocular or periocular inflammation, or both, including intermittent or persistent photophobia, epiphora, and red eyes,” Dr. Nischal reported. “There is some evidence that delayed effective treatment results in decreased final BCVA.”

Dr. Nischal’s success with flaxseed oil correlates with other surgeons’ experience. “We’ve been using all types of fish oils and omega-3s for people with dry eye and blepharitis in adults in practice,” said Maged Habib, M.D., Boynton Beach, Fla. “I personally use omega-3 fatty acids, and it helps my dry eye out a lot.”

Dr. Habib said he thinks his compelling results with dry eye also would apply to blepharokeratoconjunctivitis. “I think it would be the same effectiveness,” Dr. Habib said. “It [omega-3] regulates the good secretions of tears from the conjunctiva. It helps the basis of the problem.”

Editors’ note: Dr. Nischal has no financial interests related to this study. Dr. Habib has no financial interests related to his comments.

Contact Information

Habib: 561-742-1944, Habib1179@aol.com

Nischal: kkn@btinternet.com

A teaspoon a day could help BKC away A teaspoon a day could help BKC away
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