Sex hormones and the dry eye

Abstract

The greater prevalence of dry eye in women compared to men suggests that sex hormones may have a role in this condition. This review aims to present evidence for how sex hormones may affect the ocular structures involved in the production, regulation and maintenance of the normal tear film. It is hypothesised that hormone changes alter the homeostasis of the ocular surface and contribute to dry eye. Androgens impact on the structure and function of the meibomian and lacrimal glands and therefore androgen deficiency is, at least in part, associated with the aetiology of dry eye. In contrast, reports of the effects of oestrogen and progesterone on these ocular structures and on the conjunctiva are contradictory and the mechanisms of action of these female-specific sex hormones in the eye are not well understood. The uncertainty of the effects of oestrogen and progesterone on dry eye symptoms is reflected in the controversial relationship between hormone replacement therapy and the signs and symptoms of dry eye. Current understanding of sex hormone influences on the immune system suggests that oestrogen may modulate a cascade of inflammatory events, which underlie dry eye.

Ocular Complications of Primary Sjögren Syndrome in Men

“…Previous research has shown that dry eye is more symptomatic in women and they have greater dissatisfaction with treatment compared to men, probably due to role of sex hormones on autoimmunity. [23][24][25][26] A majority of SS literature has focused on the presentation and/or severity of disease in women, largely because of the relatively small number and highly variable clinical presentation of men with primary SS. 11 We observed a 10:1 female/male ratio, consistent with other large-scale SS studies.…”

Effects of androgen replacement therapy on cornea and tear function in men with idiopathic hypogonadotropic hypogonadism

“…To date, no clinical trial which investigates the corneal and tear function effects of systemic or topical androgen treatment in men have been published. In their latest extensive reviews, Truong et al and Versura et al pointed out the insufficient number of published clinical data about the impact of androgen therapy in dry eye [14,15]. Limited number of studies in men demonstrate that low endogenous androgenic activity especially in men using anti-androgen therapy for prostate cancer may result in ocular surface abnormalities and meibomian gland dysfunction which results in evaporative dry eye [14].…”

“…In their latest extensive reviews, Truong et al and Versura et al pointed out the insufficient number of published clinical data about the impact of androgen therapy in dry eye [14,15]. Limited number of studies in men demonstrate that low endogenous androgenic activity especially in men using anti-androgen therapy for prostate cancer may result in ocular surface abnormalities and meibomian gland dysfunction which results in evaporative dry eye [14]. Furthermore, systemic anti-androgen treatment resulted in reduced tear stability, and corneal epitheliopathy [16].…”

“…Furthermore, systemic anti-androgen treatment resulted in reduced tear stability, and corneal epitheliopathy [16]. Animal studies which mostly consisted of castrated male rats show that although lacrimal gland size, anatomy and integrity are controlled with androgen action, secretory function is not altered predominantly with androgen levels [14]. They concluded that additional modulation of androgen levels, e.g.…”

Proteomic analysis of tears following acupuncture treatment for menopausal dry eye disease by two-dimensional nano-liquid chromatography coupled with tandem mass spectrometry

“…3 Hormone replacement therapy may improve aqueous tear production but not the quality of tears in dry eye disease, and the effect on tear production is dependent upon age. 4 Nonetheless, recent studies indicate that hormone replacement therapy can increase the risk of coronary heart disease, stroke, and breast and endometrial cancers.…”