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Dry eye syndrome

Medically known as keratoconjunctivitis sicca, dry eye syndrome is a condition where the eyes feel persistently and acutely irritated and dry, and can result in ocular damage and infection. Dry eye syndrome is a leading cause of visits to the ophthalmologist, but unfortunately current treatments rarely provide adequate symptom relief.

Hormone replacement therapy and dry eyes

Strangely, several women undergoing hormone replacement therapy have complained of dry eye syndrome. Although little research has probed into the matter, some investigations have shown that estrogen appears to have an influence on the tear ducts. Hormone replacement therapy thus could contribute to the development of this condition.

In order to get to the root of the matter, Schaumberg et al. conducted a study of the relationship between hormone replacement therapy and dry eye syndrome which was part of the same Women's Health Initiative that revealed hormone replacement therapy's carcinogenic effects. This cohort study examined 39 876 postmenopausal American women aged 45 to 84 currently undergoing hormone replacement therapy.

Over the course of four years, women currently using hormone replacement therapy as well as subjects in a control group were assessed as to the presence and severity of dry eye syndrome. The researchers employed the following questions: "How often do your eyes feel dry (not wet enough)? How often do your eyes feel irritated? Have you ever been diagnosed by a clinician as having dry eye syndrome?"

The study found that use of hormone replacement therapy was strongly associated with the development of dry eye syndrome. While patients who had never undergone hormone replacement therapy were the least likely to develop the condition, women on estrogen-alone hormone replacement therapy reported the most cases (9.1%). Women on combination estrogen-progestin hormone replacement therapy had a lesser prevalence (6.7%). Women on HRT also reported the most severe symptoms of dry eye syndrome.

Researchers concluded that the high level of estrogen in hormone replacement therapy was most likely the cause of ocular difficulties in these postmenopausal women. Although more research still needs to be done, the authors of this study conclude that there is a definitive link between hormone replacement therapy and dry eye syndrome, and women as well as their doctors should take this information into account when making a decision about HRT. Alternative treatments may warrant consideration.