Menopause – Two thirds of women suffer from dry eyes

11.08.2021 11:22

During menopause, the balance of hormones in the female body changes - with well-known consequences for fertility, metabolism, sleep and the psyche. What is less known is that the eyes also react to hormonal changes: almost two thirds of all women struggle with dry eyes during and after menopause, as a current study with almost 2,000 participants from Spain shows (1). The German Ophthalmological Society (DOG) takes this as an opportunity to draw attention to the connection between hormonal balance and the occurrence of dry eye and to point out treatment options.

The eyes itch or burn, are red, and an annoying feeling of a foreign body occurs again and again - dry eye is not only unpleasant, in severe form it can also significantly impair visual acuity and quality of life (2,3). A decline in androgens is particularly important for the development or worsening of dry eye during menopause.

“The lack of androgen influence causes the so-called meibomian glands, modified sebaceous glands in the edge of the eyelid that produce the fatty portion of the tear film, to become less active,” explains Professor Dr. med. Elisabeth M. Messmer from the LMU Munich Eye Clinic. As a result, the tear film evaporates more quickly, causing dry eye symptoms and fluctuating visual acuity when working on a computer, reading or driving. “Since androgens are also responsible for the production of the watery tear film from the main tear gland and the small glands in the conjunctiva, there is a risk of tear deficiency as the androgen level drops,” says Messmer. This deficiency can lead to inflammation of the surface of the eye and damage to the cornea, further impairing vision. “This creates a real vicious circle,” emphasizes the DOG expert.

The extent to which sex hormones influence the development of dry eye has now been well studied. Studies have shown that the symptoms fluctuate in the rhythm of the menstrual cycle with its rising and falling estrogen levels (4). Women who take the pill also often complain of increased dry eye symptoms (5), whereas the symptoms usually decrease during pregnancy (6). “The initially obvious idea that hormone replacement therapy during menopause could also alleviate dry eye disease has not been confirmed,” says Messmer. On the contrary: Since the large-scale Women's Health Study with over 25,000 participants in 2001, it has been known that taking hormones - especially high-dose estrogens - actually increases the symptoms of dry eye (7).

For several years now, doctors have been trying to derive therapeutic measures from these observations. “Several studies have examined the effect of eye drops that deliver estrogen or testosterone directly to the eye,” says DOG expert Messmer. Initial results are encouraging (8.9), but larger controlled studies are needed to evaluate the effect.

Sources:

(1) Garcia-Alfaro P, Bergamaschi L, Marcos C, Garcia S, Rodríguez I. Prevalence of ocular surface disease symptoms in peri- and postmenopausal women. Menopause. 2020 Sep;27(9):993-998. doi: 10.1097/GME.0000000000001565. PMID: 32852450.

(2) P. Garcia-Alfaro, S. Garcia, I. Rodriguez & C. Vergés (2021) Dry eye disease symptoms and quality of life in perimenopausal and postmenopausal women, Climacteric, 24:3, 261-266, doi: 10.1080 /13697137.2020.1849087.

(3) Messmer EM: The pathophysiology, diagnosis and treatment of dry eye disease. Dtsch Ärztebl Int 2015; 112:71–82. doi: 10.3238/arztebl.2015.0071.

(4) Versura P, Fresina M, Campos EC. Ocular surface changes over the menstrual cycle in women with and without dry eyes. Gynecological Endocrinology: the Official Journal of the International Society of Gynecological Endocrinology. 2007 Jul;23(7):385-390. doi: 10.1080/09513590701350390. PMID: 17701769.

(5) Boga A, Stapleton F, Briggs N, Golebiowski B. Daily fluctuations in ocular surface symptoms during the normal menstrual cycle and with the use of oral contraceptives. Ocul Surf. 2019 Oct;17(4):763-770. doi: 10.1016/j.jtos.2019.06.005. Epub 2019 Jun 19. PMID: 31226422.

(6) Samuel Kyei, Richard K. Dadzie Ephraim, Stephen Animful, Madison Adanusa, Stephen Karim Ali-Baya, Belinda Akorsah, Mabel Antwiwaa Sekyere, Kofi Asiedu, “Impact of Serum Prolactin and Testosterone Levels on the Clinical Parameters of Dry Eye in Pregnant Women,” Journal of Ophthalmology, vol. 2020, Article ID 1491602, 8 pages, 2020. doi: 10.1155/2020/1491602.

(7) Schaumberg DA, Buring JE, Sullivan DA, Dana MR. Hormone replacement therapy and dry eye syndrome. JAMA. 2001 Nov 7;286(17):2114-9. doi: 10.1001/jama.286.17.2114. PMID: 11694152.

(8) Schmidl, D., Szalai, L., Kiss, OG et al. A Phase II, Multicenter, Randomized, Placebo-Controlled, Double-Masked Trial of a Topical Estradiol Ophthalmic Formulation in Postmenopausal Women with Moderate-to-Severe Dry Eye Disease. Adv Ther 38, 1975–1986 (2021). doi: 10.1007/s12325-021-01680-3.

(9) RM Schiffman, R Bradford, B Bunnell, F Lai, P Bernstein, SW Whitcup; A Multi–Center, Double–Masked, Randomized, Vehicle–Controlled, Parallel Group Study to Evaluate the Safety and Efficacy of Testosterone Ophthalmic Solution in Patients With Meibomian Gland Dysfunction. Invest. Ophthalmol. Vis. Sci. 2006;47(13):5608.