***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Dysfunction of the meibomian gl and ( MG ) is among the most frequent causes of ophthalmological symptoms . The inflammation seen in meibomian gl and dysfunction ( MGD ) is part of its pathogenesis , and evidence of the antioxidant-inflammatory properties of omega-3 fatty acids suggests this to be an appropriate treatment for MGD . Objective We aim ed to assess the effectiveness of omega-3 fatty acids versus placebo , in improving the symptoms and signs of MGD . Methods We conducted a r and omized and double-mask trial of 3 months duration . We enrolled 61 patients who presented with symptomatic MGD and no tear instability ( defined as tear breakup time [ TBUT ] < 10 seconds ) . Participants were r and omly assigned to two homogeneous subgroups . For patients in group A , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus a placebo oral agent . For patients in group B , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus oral supplementation with omega-3 fatty acids . We performed the following tests : ( 1 ) TBUT ; ( 2 ) Schirmer I test ; ( 3 ) Ocular Surface Disease Index © ( OSDI © ; Allergan , Inc. , Irvine , CA , USA ) ; ( 4 ) MG expression ; ( 5 ) evaluation of lid margin inflammation ; and ( 6 ) interpalpebral and corneal dye staining . Results After 3 months of evaluation , the mean OSDI , TBUT , lid margin inflammation , and MG expression presented improvement from the baseline values , in group B ( P < 0.01 , P < 0.001 , P < 0.0001 , P < 0.0001 , respectively ) . The Schirmer test results were also improved and statistically significant ( P < 0.01 ) . Conclusion Oral omega-3 fatty acids , 1.5 grams per day , may be beneficial in the treatment of MGD , mainly by improving tear stability Purpose To evaluate the effect of a new , prescription-only medical food supplement containing omega-3 and omega-6 essential fatty acids on  dry eye signs and symptoms  , with or without concomitant topical cyclosporine . Methods A total of 43 subjects were r and omized and followed for 6 months . Group 1 ( n = 23 ) was assigned to take two soft geltabs of the medical food supplement by mouth twice daily for 6 months . Group 2 ( n = 20 ) was directed to take the medical food supplement in the same manner , along with topical cyclosporine , instilled twice daily during the last 3 months of the study . Subjects were evaluated at baseline , month 1 , month 3 , and month 6 . Primary outcome measures included tear breakup time ( TBUT ) , conjunctival staining , corneal staining , and change in subjective symptoms . Results Both groups had a statistically significant improvement in TBUT between baseline and month 6 . In the food supplement only group , TBUT improved by 0.805 seconds from baseline to month 6 . In the supplement/cyclosporine group , TBUT improved by 1.007 seconds from baseline . There was no statistically significant difference in TBUT between the two groups at baseline , month 3 , or month 6 . There were no significant differences in corneal or conjunctival staining between or within groups . Subjective symptoms were also improved in both groups . Conclusion Supplementation with the proper balance of omega-3 and omega-6 essential fatty acids improved TBUT and relieved patient symptoms . The addition of topical cyclosporine did not convey any statistically significant improvement in TBUT beyond that achieved by the supplement BACKGROUND Dry eye syndrome ( DES ) is a prevalent condition , but information on risk or protective factors is lacking . OBJECTIVE We aim ed to determine the association between the dietary intake and ratio of n-3 and n-6 fatty acids ( FAs ) and DES occurrence . DESIGN Of the 39876 female health professionals in the Women 's Health Study ( WHS ) , 32470 women aged 45 - 84 y who provided information on diet and DES were cross-sectionally studied . We assessed FA intakes by using a vali date d food-frequency question naire and assessed  DES  by using self-reports of clinical ly diagnosed cases . Of the sample , 1546 ( 4.7 % ) subjects reported DES .  We used logistic regression models to estimate the odds ratios ( ORs ) and 95 % CIs to describe the relation of FA intake with DES . RESULTS After adjustment for demographic factors , hormone therapy , and total fat intake , the OR for the highest versus the lowest quintile of n-3 FAs was 0.83 ( 95 % CI : 0.70 , 0.98 ; P for trend = 0.05 ) . A higher ratio of n-6 to n-3 FA consumption was associated with a significantly increased risk of DES ( OR : 2.51 ; 95 % CI : 1.13 , 5.58 ) for > 15:1 versus < 4:1 ( P for trend = 0.01 ) . In addition , tuna consumption [ 1 serving was 113 g ( 4 oz ) ] was inversely associated with DES ( OR : 0.81 ; 95 % CI : 0.66 , 0.99 for 2 - 4 servings/wk ; OR : 0.32 ; 95 % CI : 0.13 , 0.79 for 5 - 6 servings/wk versus < or = 1 serving/wk ; P for trend = 0.005 ) . CONCLUSIONS These results suggest that a higher dietary intake of n-3 FAs is associated with a decreased incidence of  DES in women . These findings are consistent with anecdotal clinical observations and postulated biological mechanisms Purpose : The aim of this study was to evaluate the effect of dietary omega-3 fatty acid ( O3FA ) supplementation on dry eye symptoms , tear film tests , and conjunctival impression cytology in patients with contact lens wear – associated dry eye . Methods : In this r and omized , double-blind , multicentric trial , contact lens wearers ( n = 496 ) were r and omized to receive either O3FAs or placebo capsules ( corn oil ) twice daily for 6 months . Subjects underwent examinations at baseline , 3 months , and 6 months . At each visit , a question naire of dry eye symptoms and lens wear comfort was administered . Subjects further underwent measurement of tear film break-up time ( TBUT ) and a Schirmer test . Conjunctival impression cytology was performed by the transfer method . Improvement in symptoms and lens wear comfort were primary outcome measures . Changes from baseline in TBUT , Schirmer , and Nelson grade at 6 months were secondary outcome measures . Results : The mean improvement in symptom score in the O3FA group was 4.7 ± 2 ( 2.0 ) as compared with 0.5 ± 2 ( 0.9 ) in the placebo group ( P < 0.0001 ) . Lens wear comfort levels improved significantly ( P < 0.0001 ) from baseline . There was a significant increase in TBUT [ 3.3 ± 2 ( 1.5 ) ] and Nelson grade [ 0.7 ± 2 ( 0.6 ) ] in the O3FA group ( P < 0.0001 ) as compared with 0.3 ± 2 ( 0.6 ) and 0.1 ± 2 ( 0.4 ) in the placebo group ( P = 0.164 and 0.094 , respectively ) . However , the magnitude of increase in Schirmer score [ 2.0 ± 2 ( 1.5 ) ] was relatively small ( P = 0.08 ) . Conclusions : The results of this study point toward benefits of orally administered O3FAs in alleviating dry eye symptoms , improving lens wear comfort , and cytological changes in contact lens wearers Purpose : To investigate the potential effect of dietary supplementation with omega-3 fatty acid on lipid composition of meibum , aqueous tear evaporation , and tear volume in patients with dry eye . Methods : In a pilot , prospect i ve , r and omized , double-masked study , patients with dry eye received a daily dose of fish oil , containing 450 mg of eicosapentaenoic acid , 300 mg of docosahexaenoic acid , and 1000 mg of flaxseed oil ( TheraTears Nutrition ; Advanced Vision Research , Woburn , MA ) for 90 days . There were 2 patient visits : baseline and final . At these visits , patients completed the ocular surface disease index to score subjective symptoms , and slit-lamp examinations , breakup time , corneal staining , Schirmer type I , fluorophotometry , evaporometry , and collection of meibomian gl and secretion sample s for lipid composition analysis were performed . Results : A total of 36 patients with dry eye completed the study . At the end of the study , 70 % of the patients became asymptomatic , whereas for the placebo group , 7 % of the symptomatic patients became asymptomatic . Schirmer testing and fluorophotometry suggested that the omega-3 supplement increased tear secretion . The lipid composition of the sample s collected from the omega-3 group was found to be very similar to that from the placebo group . No trends between groups were seen for other objective parameters . Conclusions : Dietary supplementation with omega-3 fatty acids in dry eye showed no significant effect in meibum lipid composition or aqueous tear evaporation rate . On the other h and , the average tear production and tear volume was increased in the omega-3 group as indicated by both Schirmer testing and fluorophotometry Dry eye is a common condition that can severely impair the quality of life . We aim ed to find out whether oral sea buckthorn ( SB ) oil , containing ( n-3 ) and ( n-6 ) fatty acids and antioxidants , affects dry eye . In this double-blind , r and omized , parallel trial , 20- to 75-y-old women and men experiencing dry eye symptoms consumed 2 g of SB or placebo oil daily for 3 mo from fall to winter . One hundred participants were recruited and 86 completed the study . Clinical dry eye tests and symptom follow-ups were performed . Tear film hyperosmolarity is a focal factor in dry eye . There was a general increase in the osmolarity from baseline to the end of the intervention . Compared with the placebo group , the increase was significantly less in the SB group when all participants were included [ intention to treat ( ITT ) , P = 0.04 ] and when only participants consuming the study products for at least 80 % of the intervention days were included [ per protocol ( PP ) , P = 0.02 ] . The maximum intensities of redness and burning tended to be lower in the SB group . In the ITT participants , the group difference was significant for redness ( P = 0.04 ) but not for burning ( P = 0.05 ) . In the PP participants , the group difference was significant for burning ( P = 0.04 ) but not for redness ( P = 0.11 ) . In conclusion , SB oil attenuated the increase in tear film osmolarity during the cold season and positively affected the dry eye symptoms PURPOSE To evaluate if oral flaxseed oil ( Linum usitatissimum ) , which reduces the inflammation in rheumatoid arthritis , may help keratoconjunctivitis sicca 's treatment in Sjögren 's syndrome patients . METHODS In a r and omized clinical trial , 38 female patients with rheumatoid arthritis or systemic lupus erithematosus associated with keratoconjunctivitis sicca and Sjögren 's syndrome were consecutively selected from patients of the Department of Rheumatology of the Amazonas University Hospital . Keratoconjunctivitis sicca diagnosis was based on a dry-eye symptom survey score ( Ocular Surface Disease Index - OSDI ) , Schirmer-I test , fluorescein break-up time , 1 % Rose Bengal staining of ocular surface measured by the van Bijsterveld scale .  All patients had ocular surface inflammation evaluated and quantified by conjunctival impression cytology , before and after the study . The subjects were divided into three groups with 13 ( Group I ) , 12 ( Group II ) and 13 ( Group III ) patients . Group I received flaxseed oil capsules with a final 1 g/day dosis , Group II flaxseed oil capsules with a final 2 g/day dosis and Group III - controls - placebo , for 180 days . RESULTS Comparing the results at the beginning and at the end of the treatment , statistically significant changes ( p<0.05 ) in symptoms ( OSDI ) , ocular surface inflammation quantified by conjunctival impression cytology , Schirmer-I test and fluorescein break-up time occurred in Groups I e II when compared to controls . CONCLUSIONS Therapy with oral flaxseed oil capsules 1 or 2 g/day reduces ocular surface inflammation and ameliorates the symptoms of keratoconjunctivitis sicca in Sjögren 's syndrome patients . Long-term studies are needed to confirm the role of this therapy for keratoconjunctivitis sicca in Sjögren 's syndrome PURPOSE To evaluate by in vivo laser scanning confocal microscopy ( LSCM ) the morphologic changes in the meibomian gl and s ( MGs ) and the status of perigl and ular inflammation  in contact lens wearers ( CLWs ) and to investigate the correlations 
    Output:
    
We observed a discrete improvement in the parameters of tear function .
Scientific evidence is not strong enough to systematic ally recommend the use of omega-3 and omega-6 fatty acids as a st and alone treatment of DES independently from its aetiology .
However , they could be considered as an effective alternative to topical treatment in patients with DES secondary to certain pathologies