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Dry eye in postmenopausal women: a hormonal disorder

Sriprasert, Intira MD; Warren, Dwight W. PhD; Mircheff, Austin K. PhD; Stanczyk, Frank Z. PhD

doi: 10.1097/GME.0000000000000530
Review Articles

Objective: This review examines the etiology and pathophysiology of dry eye disease in postmenopausal women, and describes the steroid reproductive hormone influences that may contribute to its development.

Methods: We have reviewed the relevant studies on dry eye disease related to hormonal status and hormone therapy (HT) in both animal models and humans.

Results: Although both low and high estrogen levels have been associated with symptoms of dry eye disease, low androgen levels are a more consistent factor in its etiology. Postmenopausal HT with estrogen or estrogen plus progestogen has shown a limited benefit for dry eye symptoms and may even result in progression of meibomian gland dysfunction, decreased tear film break up time, and tear flow reduction. However, systemic or local androgen treatment has shown promising results in improving dry eye symptoms.

Conclusions: Because of the high incidence of dry eye among postmenopausal women that may be related to the hormonal treatment, we propose that a multidisciplinary approach should be considered between gynecologists and ophthalmologists in management of this disorder.

1Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

2Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA

3Department of Cell and Neurobiology, Keck School of Medicine, University of Southern California, Los Angeles, CA

4Department of Physiology and Biophysics, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Address correspondence to: Frank Z. Stanczyk, PhD, Livingston Reproductive Biology Laboratories, Room#201, 1231 North Mission Road, Los Angeles, CA 90033. E-mail:

Received 18 February, 2015

Revised 30 June, 2015

Accepted 30 June, 2015

Funding/support: None.

Financial disclosure/conflicts of interest: I.S. and D.W.W. have no conflicts of interest. A.K.M. is a consultant for Allergan and past recipient of unrestricted grants on animal models for inflammatory lacrimal gland disease. F.S. is a consultant for Merck Co, Agile Therapeutics, Noven, AbbVie, and Therapeutics MD.

© 2016 by The North American Menopause Society.