Ocular surface changes over the menstrual cycle in women with and without dry eye.
Gynecol Endocrinol. 2007 Jul;23(7):385-90. Versura P, Fresina M, Campos EC. Department of Surgical Science and Transplants, Section of Ophthalmology, Alma Mater Studiorum Università di Bologna, Bologna, Italy.
Aim. To analyze whether dry eye symptoms and ocular surface parameters change during different phases of the menstrual cycle. Method. Twenty-nine women of fertile age and with regular, 26-29-day menstrual cycles were included in the study. Fourteen subjects suffered and 15 did not suffer from dry eye symptoms. Symptoms were scored by the validated Ocular Surface Disease Index questionnaire. Tear production was evaluated with the Schirmer I test and the Schirmer II test (Jones test); tear stability with tear breakup time and Ferning test; and degree of dryness by the tear function index and imprint conjunctival cytology. Degree of inflammation was evaluated with conjunctival brush cytology and concentration of exudated serum albumin in tears. Hormonal cytology procedures were applied to exfoliated cells in tears. Patients were analyzed during menstruation, in the follicular phase and the luteal phase over two consecutive cycles, and results were statistically evaluated. Results. Subjective symptoms, tear production and stability, surface dryness and inflammation were significantly related to hormonal fluctuations in the menstrual cycle. In particular, the impairment of these functions appeared to be related to the estrogen peak occurring during the follicular phase, especially in patients with dry eye. Conclusion. The ocular surface is confirmed to be an estrogen-dependent unit; clinicians should take into account these cyclic variations during examination of subjects affected by symptoms of eye dryness.
By the way, did you notice how thorough those methods were... no fewer than 9 different testing methods (1 for symptoms, 8 for clinical signs). I am definitely getting a reprint of this study which hopefully will be generous with data on how results varied amongst the different markers.
Note that the study lead (Dr. Versura) had a previous publication about this in the same journal back in 2005:
Menopause and dry eye. A possible relationship.
...In post-menopausal women endocrine changes join the aging effects in the pathogenesis of dry eye, but still it remains controversial whether estrogen or androgen deficiency or their imbalance impair ocular surface function. Another questionable issue concerns the efficacy of hormonal replacement therapy in the amelioration of dry eye symptoms and recovery of tear function, since the scientific literature stands in between a therapeutic or a promoting effect of eye dryness. ...estrogen or androgen-based eye drops represents a promising innovative treatment based upon important scientific rationale.
6 comments:
Very interesting. I have always wondered about a estrogen component. My acute onset was shortly after chemo which put me in menopause overnight at the age of 47. I am in the severe category and am just starting to read about the sclera contact, as my MD told me yesterday he can't do anymore for me and wants to refer me to Indy corneal specialist or even Dr. Latkany in NY. I am also on an anti cancer drug (Femara) that helps in getting rid of all estrogen as my cancer was estrogen driven. I just found your site and am grateful for your information, this is a lonely dissease, not many understand how awful it is. Going throught chemo was easier!
I have very dry eyes since I became hypopituitary which means that I lack all hormones! I have to replace many of the hormones, and I have low estrogen levels. From what I have read about dry eyes it is the opposite (excess of estrogen) that causes dry eyes. I do not understand why I would have dry eyes, but I have just started using Restasis after the pluggs failed me. When I use the tear drops they feel good for about 5 seconds and then they're gone.
I have dry eye inflmamation attacks prior or after my mensturation.
Very interesting indeed. I am 53 and since August when I went from cycling every 27 days to 45 days or longer between cycles (not sure I would call it that since it's only been spotting) I have been miserable. My eyes itch, tear and hurt. I have used all of the over the counter "dry eye" products as well as Restasis, but have not found any relief. All I can say is HELP!!!!!!
As previously mentioned it is a very lonely problem. I have been to A&E countless times as I can't stand the pain my eyes give me. It feels like someone is constantly throwing vinegar in my eyes.
I've been struggling for over 3 years and had every test possible for a cause. It came out yesterday that my eyes might be linked to my cycle so fingers crossed that a solution is found as I can't go to work, I can't sleep...I can't do anything!
Ladies,
I had dry eyes with headaches and fatigue and I had my iron levels tested. My ferritin (stored iron) was extremely low. Iron is responsible for transporting oxygen to all cells in your body (including your eyes) and dry eyes are often a result of LACK of oxygen to the surface of the eye (according to my eye doc).
The OTC iron supplements HELPED and provided relief.
One note: I'd recommend a HEME (animal source) iron supplement, because there are so many things that interfere with the absorption of NONHEME (plant-based) iron supplements.
Just an idea and a simple solution, but of course check with your doc on this!
Jen
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