This study evaluates the effect of dietary omega-3 fatty acid supplementation of dry eye symptoms, tear film tests, and conjunctival impression cytology in patients with contact lens wear-associated dry eye. In this randomised double-blind, multi-centred trial, contact lens wearers (n= 496) were randomised to receive either omega-3 fatty acids or placebo capsules (corn oil) twice daily for six months. At each visit a questionnaire of dry eye symptoms were completed, tear film break up time (TBUT), Schirmer’s test, conjunctival impression cytology. Outcomes measures were improvement in symptoms and lens wear comfort. Changes in TBUT, Schirmer’s test and Nelson grade (conjunctival impression cytology scores) at six months were secondary outcomes. Exclusion criteria were: current ocular infection, history of laser refractive surgery, allergic conjunctivitis, herpetic eye disease, diabetes, liver disease, pregnancy, lactation, HIV, hepatitis, those on systemic tetracyclines, systemic corticosteroids, topical medications other than artificial tears. Computer use was not allowed for the duration of the study. The mean contact lens wear time was 3.1 +/- (0.91) years in the omega-3 fatty acid supplements group and 3.3 +/- 2 (1.6) years. Noncompliance and gastric irritation resulted in 14 patients dropping out of the trial. The mean age was comparable in both groups. Patients were instructed not to use artificial tears two hours before testing. The mean improvement in symptom score was significantly improved from baseline for the cohort receiving omega-3 supplements versus the placebo group, this was associated with a significant increase in TBUT. However, improvement in Schirmer’s test was small. Omega-3 is an essential fatty acid that can’t be synthesised by the body but has to be ingested. It has anti-inflammatory properties. Omega-6 fatty acids are pro-inflammatory. The ratio of omega-3 and omega-6 determines the overall inflammatory status of the body.