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Sex hormones affect dry eye


Sex hormones and dry eye


Dry eye is impacted by changes in the levels of your sex hormones – that goes for both men and women



The main sex hormones are oestrogen, testosterone and progesterone. The level of these hormones gradually falls over the course of our lives, with a sharper fall off around the time of the menopause for women. Women also experience fluctuations throughout the monthly menstrual cycle. There have been many scientific studies linking changes in hormonal levels with shifts in the severity of dry eye symptoms. And because dry eye is recognised as an inflammatory disease and sex hormones have a big impact on the immune system, Dry Eye Zone wanted to investigate further.


What is being affected

Dry eye is a is a multifactorial disease caused by a reduction in the quality and quality of our natural tear-film production. The tear-film consists of three distinct layers, each layer is produced by a series of glands and specialised cells found around the eye. They consist of the lacrimal glands, these are the largest of the glands, and can be found just above the eye towards the outer side of the eyelid.. They produce the watery aqueous component of our tears.

You also have meibomian glands the openings of which are found along the edge of both of your eyelids. These glands produce an oil called meibum. Meibum has an essential role in slowing the evaporation of the aqueous element of your tear-film.

Lastly, you have specially adapted cells called goblet cells which secrete mucin onto the ocular surface (although they do get a bit of help from special cells in the lacrimal glands and the corneal epithelium), this layer is the anchor to hold all three layers onto the surface of the eye.


Dry eye and the menstrual cycle

The very fact that dry eye is more prevalent in women compared with men suggests that the sex hormones may play a role. Both oestrogens and progesterone have been linked to the suppression of meibum production. A study published in the Journal of Clinical Ophthalmology and Eye Disorders tracked the level of dry eye clinical signs in more than 200 women. The researchers concluded that where the oestrogen level was highest this correlated with increased dry eye scores. It is thought that higher oestrogen levels might be causing reduced meibomian gland secretion. However, not all studies agree with these findings, one study showed contradictory results with dry eye symptoms being worse when the oestrogen level was lowest.

The eye is without doubt changing during the normal menstrual cycle, this includes changes to the thickness of the surface of the eye and increased signs of inflammation. The situation is complex and far from clear - more research is definitely needed.

If you do have fluctuating dry eye throughout the month be sure to mention this to your eye care professional


Dry eye and pregnancy

You are more likely to experience dry eye when pregnant due to the changes in hormone levels. This increased incidence becomes even more noticeable as the age of the mother increases.

Although you have 70% more testosterone, a hormone which supports tear production this might be offset by the steady rise in oestrogen, peaking in the third trimester. Oestrogen levels are considerably higher while pregnant which could explain the incidence of dry eye. Your eyecare professional will recommend suitable eye drops for use during pregnancy as well ask checking your eyes in general as other ocular changes also occur during pregnancy.

The good news is that these changes will most likely disappear after giving birth.


Dry Eye and hormonal contraceptives

There is a clear link between using hormonal contraceptives (HCs) and the incidence of dry eye diseases. The likelihood of developing dry eye increased the longer HCs were used and the higher the quantities used. The situation can be made even worse if you are also a contact lens wearer.

If you are using HCs, especially over long periods of time, take measures to manage these symptoms. Dry eye is a progressive disease, and will not just go away, the best place to start taking control is with a visit to your eye care professional.


Dry eye and the menopause

There is a lot happening to the body during the menopause and changes to the sex hormones are of course part of this. A survey found that 62% of women who were going through the menopause, or perimenopause, had dry eyes. So it is a very common problem.

Women have a low level of testosterone naturally but during the menopause this starts to fall away along with the level of oestrogen and progesterone. This could be the trigger for dry eye symptoms, in particular meibomian gland dysfunction.


There have been numerous studies investigating the link between hormone replacement therapy (HRT) and dry eye symptoms. The results are often conflicting and also depend on whether the supplement is oestrogen only or a combination of oestrogen and progesterone. It just goes to show how complex the interactions are between these hormones and the multifactorial nature of dry eye.


Dry eye and men

Male hormones (androgens), such as testosterone, are linked to the structure and function of both meibomian and lacrimal glands. Studies have shown that an androgen deficiency has a negative effect on meibomian gland function which could be responsible for increased dry eye. As testosterone falls with age the incidence of dry eye is likely to increase. Men get dry eye too so it is important they look after their eyes and get professional advice on managing any symptoms.



If you are experiencing dry eye symptoms then you should ask the advice of your eye care professional. Do not leave things untreated as symptoms may progress. Why not book your next eye examination with an independent optician today.

Sources:

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Dr. Russel Lazarus, Optometry Network. Dry Eye and Menopause. September 3, 2020


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