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Hormonal factors in the tear film

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  • Hormonal factors in the tear film

    TFOS DEWS II Tear Film Report

    6.2 Hormonal factors

    Low androgen levels have been reported to be consistently associated with dry eye [599]. Biophysical and biochemical changes in the tear film in postmenopausal women have been investigated in a few studies. Tear osmolarity in postmenopausal women with dry eye symptoms were shown to be significantly higher than those without symptoms [124], and sex hormone levels correlated with tear osmolarity [600,601]. Tear ferning tests were also reported to have higher grades in postmenopausal women with dryness complaints than asymptomatic postmenopausal women [124]. As for the biochemical changes, although tear film levels of lipocalin and lysozyme do not seem to change in postmenopausal women with dry eye [602], in one study lactoferrin levels were reported to significantly decrease [603]. The effect of hormone replacement therapy is controversial; some studies suggested it improves tear function tests and increases goblet cell density [604,605], whereas, others reported hormone replacement therapy (particularly estrogen alone) to be associated with a higher risk of dry eye [606]. A further, more exhaustive discussion on this topic is provided in the TFOS DEWS II Sex, Gender, and Hormones report [607].
    Thyroid eye disease may be associated with tear function abnormalities. Increased dryness symptoms, decreased tear film breakup time, decreased corneal sensitivity, and increased ocular surface staining have been reported both during the active and inactive phases of Graves' ophthalmopathy [608,609]. Increased tear osmolarity [610,611] and increased levels of inflammatory mediators such as IL-1β, IL-6, IL-8 and plasminogen activator inhibitor-1 have also been found in the tear film of patients with active Graves' ophthalmopathy [609,612].
    References in this excerpt:
    [124] Srinivasan S, Joyce E, Jones LW. Tear osmolality and ferning patterns in postmenopausal women. Optom Vis Sci 2007;84:588592.
    [599] Mathers WD, Stovall D, Lane JA, Zimmerman MB, Johnson S. Menopause and tear function: the influence of prolactin and sex hormones on human tear production. Cornea 1998;17:353358.
    [600] Gagliano C, Caruso S, Napolitano G, Malaguarnera G, Cicinelli MV, Amato R, et al. Low levels of 17-beta-oestradiol, oestrone and testosterone correlate with severe evaporative dysfunctional tear syndrome in postmenopausal women: a case-control study. Br J Ophthalmol 2014;98:371376.
    [601] Scuderi G, Contestabile MT, Gagliano C, Iacovello D, Scuderi L, Avitabile T. Effects of phytoestrogen supplementation in postmenopausal women with dry eye syndrome: a randomized clinical trial. Can J Ophthalmol 2012;47:489492.
    [602] Srinivasan S, Joyce E, Boone A, Simpson T, Jones L, Senchyna M. Tear lipocalin and lysozyme concentrations in postmenopausal women. Ophthalmic Physiol Opt 2010;30:257266.
    [603] Careba I, Chiva A, Totir M, Ungureanu E, Gradinaru S. Tear lipocalin, lysozyme and lactoferrin concentrations in postmenopausal women. J Med Life 2015;8(Spec Issue):9498.
    [604] Taner P, Akarsu C, Atasoy P, Bayram M, Ergin A. The effects of hormone replacement therapy on ocular surface and tear function tests in postmenopausal women. Ophthalmologica 2004;218:257259.
    [605] Pelit A, Bagis T, Kayaselcuk F, Dursun D, Akova Y, Aydin P. Tear function tests and conjunctival impression cytology before and after hormone replacement therapy in postmenopausal women. Eur J Ophthalmol 2003;13:337342.
    [606] Schaumberg DA, Buring JE, Sullivan DA, Dana MR. Hormone replacement therapy and dry eye syndrome. JAMA 2001;286:21142119.
    [607] Sullivan DA, Rocha EM, Aragona P, Clayton JA, Ding J, Golebiowski B, et al. TFOS DEWS II Sex, Gender, and Hormones report. Ocul Surf 2017;15:284333.
    [608] Xu N, Huang D, Yang H, Lai Z, Luo Q. Ocular surface characteristics and impression cytology in patients with active versus inactive Thyroid Eye Disease. Eye Sci 2012;27:6468.
    [609] Huang D, Xu N, Song Y, Wang P, Yang H. Inflammatory cytokine profiles in the tears of thyroid-associated ophthalmopathy. Graefes Arch Clin Exp Ophthalmol 2012;250:619625.
    [610] Gilbard JP, Farris RL. Ocular surface drying and tear film osmolarity in thyroid eye disease. Acta Ophthalmol (Copenh) 1983;61:108116.
    [611] Iskeleli G, Karakoc Y, Abdula A. Tear film osmolarity in patients with thyroid ophthalmopathy. Jpn J Ophthalmol 2008;52:323326.
    [612] Ujhelyi B, Gogolak P, Erdei A, Nagy V, Balazs E, Rajnavolgyi E, et al. Graves' orbitopathy results in profound changes in tear composition: a study of plasminogen activator inhibitor-1 and seven cytokines. Thyroid 2012;22:407414.
    Rebecca Petris
    The Dry Eye Foundation