'Dry eye' in women may be linked to sex hormones

February 09, 2004

CHICAGO - Women whose ovaries prematurely cease functioning may be at a greater risk for dry eye symptoms, according to an article in the February issue of The Archives of Ophthalmology, one of the JAMA/Archives journals.

Premature ovarian failure (POF) occurs when the ovaries stop functioning normally in women under 40 years and affected approximately 1 percent of women in a large study, according to the article. Women with POF experience the same symptoms of estrogen deficiency as postmenopausal women, including hot flashes, night sweats, fatigue, and mood swings, and have an increased risk of cardiovascular disease and osteoporosis. Androgen deficiency (low levels of the male hormone androgen), has been associated with dry eye, a condition affecting an estimated 15 percent of people in the United States aged 65 to 84 years. Reduced tear production and poor tear quality (causing moisture to evaporate from the surface of the eye too quickly) can result in dry eye. Because women with POF also have androgen deficiency, it is possible that POF and dry eye symptoms may be associated.

Janine A. Smith, M.D., of the National Eye Institute, Bethesda, Md., and colleagues investigated the association between POF and dry eye. They examined 65 women with POF and 36 women without POF for symptoms of dry eye.

The researchers found the proportion of patients that met dry eye diagnostic criteria was significantly greater among women with POF than women without POF (20 percent vs. 3 percent).

"Women with POF were more likely to exhibit ocular surface damage and symptoms of dry eye than age-matched controls. They were not, however, more likely to have reduced tear production," the authors write. "These data provide further evidence of the multifaceted role of sex hormones in the health and disease of the ocular surface."
(Arch Ophthalmol. 2004;122:151-156. Available post-embargo at archophthalmol.com)

Editorial: Hormonal Deficiencies and Dry Eye

In an accompanying editorial, Stephen C. Pflugfelder, M.D., of Houston, writes, "The study by Smith et al did not determine which hormones are most important in maintaining [balanced moisture on the surface of the eye] or whether deficiencies of androgen, estrogen, or both hormones were responsible for the observed ocular surface abnormalities. Additional studies of patients with POF could answer these questions."

(Arch Ophthalmol. 2004:122:273-274. Available post-embargo at archophtalmol.com)

To contact Janine A. Smith, M.D., call Michael Coogan at 301/496-5248.
To contact editorialist Stephen C. Pflugfelder, M.D., call Ruthie McNeill at 713-798-4732.
For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

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