Patient Guide
The guide Dr. Eslani gives his dry eye patients in San Diego: the daily habits that make a difference, what to eat and drink, and an honest scorecard for fish oil, vitamins, and eye vitamins. No food or pill cures dry eye. These steps add to your drops, lid cleaning, and heated mask; they do not replace them.
The Honest Truth
Your drops, lid cleaning, and heated mask do the heavy lifting. Supplements help less than the ads claim.
Daily habits decide how fast your tears evaporate: how often you blink at a screen, how dry the air around you is, and whether smoke or alcohol is irritating your eyes. What you eat matters too, mainly the balance of omega-3 and omega-6 fats.
This guide sorts what the research supports from what it does not, so your effort and money go where they count.
Preservative-free artificial tears, at least 6 times a day
Eyelid cleaning, morning and bedtime
A heated mask and eyelid massage, 3 to 4 times a day
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Every Day
Small changes to your screen time, air, and routine can make your tears last longer.
Screens: every 20 minutes, look 20 feet away for 20 seconds and blink fully. Screens make you blink less often, and less completely.
Air: run a humidifier where you sleep or work. Point fans and car vents away from your face.
Smoke and alcohol: avoid smoke, including other people's. Even one drink can make tears less stable for a few hours.
Sleep: poor sleep makes dry eye worse. Use a CPAP machine? Tell us, because a leaky mask can blow air onto your eyes.
Medicines: allergy pills, some bladder pills, and the acne pill isotretinoin can dry the eyes. Do not stop them. Ask your doctor about options.
Food and Drink
The best evidence is for the balance of fats in your diet: more omega-3, fewer heavily processed omega-6 oils.
Oily fish twice a week, such as salmon, sardines, mackerel, or trout, plus walnuts, ground flax, or chia. In more than 32,000 women, those who ate the most omega-3 had less dry eye.
Fewer fried and packaged foods. Diets very high in omega-6 oils and low in omega-3 were linked to 2.5 times the odds of dry eye.
Water: drink normally. Extra water has not been shown to help dry eye.
Coffee is fine. Caffeine does not cause dry eye.
Alcohol: keep it light. Even one drink can make tears less stable for a few hours.
Supplements
Patients spend a lot on supplements for dry eye. Here is what the research shows, and what to do.
Mixed results
The largest U.S. trial, 535 people for one year, found fish oil no better than a placebo, and a trial of more than 23,000 adults found daily fish oil did not prevent dry eye. Other studies show small benefits. It is optional: try it for 3 months and stop if nothing changes. More than 1 gram a day can raise the risk of an irregular heartbeat, so ask your doctor first, especially if you take a blood thinner.
Only if low
Low levels are linked to dry eye, but taking extra when your levels are normal has not been shown to help. Ask for a blood test and replace only what is low. Too much vitamin A is harmful.
Not for dry eye
These are made for macular degeneration. They do not treat dry eye.
The Treatment That Works
If you have done the daily steps for 4 to 6 weeks and still have symptoms, the next step is finding out exactly which type of dry eye you have.
First
Tear break-up time, surface staining, and a close look at the eyelids and oil glands show which type of dry eye you have.
Prescription
Prescription drops can calm the inflammation that keeps dry eye going.
In the office
Treatments that clear blocked oil glands more thoroughly than home heat and massage.
Advanced
For severe or stubborn cases, including autologous serum tears and punctal plugs.
What the Research Says
Evidence reviewed October 2026.
Am J Clin Nutr, 2005
In 32,470 women, the highest omega-3 intake was linked to less dry eye, and a high omega-6 to omega-3 ratio to 2.5 times the odds.
Read the study ↗N Engl J Med, 2018
In 535 people with dry eye, a year of fish oil worked no better than an olive oil placebo.
Read the study ↗JAMA Ophthalmology, 2022
In 23,523 adults followed for about five years, daily fish oil did not lower the rate of new dry eye.
Read the study ↗Circulation, 2021
Across large trials, more than 1 gram a day of fish oil was linked to a higher risk of atrial fibrillation.
Read the study ↗FAQ
Persistent dry eye has a cause that can be found and treated. Request a dry eye evaluation with Dr. Eslani.