Journal List > J Korean Ophthalmol Soc > v.51(2) > 1008723

TOOLS
Moon, Jung, Shin, and Paik: Effect of Hormone Replacement Therapy on Dry Eye Syndrome in Postmenopausal Women: A Prospective Study
Original Article

J Korean Ophthalmol Soc 2010;51(2):175-179.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.2.175

Effect of Hormone Replacement Therapy on Dry Eye Syndrome in Postmenopausal Women: A Prospective Study

Jung Hyun Moon, MD1, Jee Woong Jung, MD2, Kyung Hwan Shin, MD, PhD1, Hye Jung Paik, MD, PhD1

1Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea

2Department of Ophthalmology, The Armed Forces Hampyeong Hospital, Hampyeong, Korea

Address reprint requests to Hye Jung Paik, MD, PhD Department of Ophthalmology, Gachon University Gil Medical Center #1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358, E-mail: hjpaik@gilhospital.com

Received 19 June 2009       Accepted 19 October 2009

Copyright © 2010 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effects of conjugated hormone replacement therapy (HRT) on dry eye syndrome in postmenopausal women.

Methods

Thirty-six healthy postmenopausal women (72 eyes) were included in this three-month prospective study. Schirmer test, tear film breakup time (BUT), fluorescein staining score and symptom score were performed on all patients at the time of enrollment, one month and three months after initiation of HRT. All patients received HRT consisting of conjugated estrogen and progesterone taken orally in a continuous combined regimen.

Results

Symptom score significantly decreased from 2.10±0.79 before HRT to 1.32±0.84 after one month and to 0.88±0.67 after three months (p＜0.001). In addition, tear film BUT measurements significantly increased from 6.04±2.54 seconds to 7.99±2.43 seconds after one month and to 8.93±2.20 after three months (p＜0.001). The fluorescein staining score was 0.94±0.71 before HRT and decreased to 0.42±0.60 after one month and to 0.22±0.42 after three months (p＜0.001).

Conclusions

Hormone replacement therapy consisting of conjugated estrogen and progesterone significantly improved the symptoms and signs of dry eye syndrome in postmenopausal women.

Keywords: Dry eye syndrome, Hormone replacement therapy, Postmenopausal woman

References

1. Gamache DA, Dimitrijevich SD, Weimer LK, et al. Secretion of proinflammatory cytokines by human conjunctival epithelial cells. Ocul Immunol Inflamm. 1997; 5:117–28.
crossref
2. Lemp MA. Report of the National Eye Institute/Industry aberrations on clinical trials in dry eyes. CLAO J. 1995; 21:221–32.
3. Guttridge NM. Change in ocular and visual variables during the menstrual cycle. Ophthalmic Physiol Opt. 1994; 14:38–48.
4. Wickham LA, Geo J, Toda I, et al. Identification of androgen, estrogen and progesterone receptor mRNAs in the eye. Acta Ophthalmol Scand. 2000; 78:146–53.
crossref
5. Chia EM, Mitchell P, Rochtcina E, et al. Prevalence and associations of dry eye syndrome in an older population: The Blue aberrations Eye Study. Clin Experiment Ophthalmol. 2003; 31:229–32.
6. Evans V, Millar TJ, Eden JA, Willcox MD. Menopause, hormone replacement therapy and tear function. Adv Exp Med Biol. 2002; 506:1029–33.
crossref
7. Pelit A, Bagis T, Kayaselcuk F, et al. Tear function tests and conjunctival impression cytology before and after hormone replacement therapy in postmenopausal women. Eur J Ophthalmol. 2003; 13:337–42.
crossref
8. Schaumberg DA, Buring JE, Sullivan DA, et al. Hormone replacement therapy and dry eye syndrome. JAMA. 2001; 286:2114–9.
crossref
9. Kim SC, Suh Y, Chung SK. Relationship between dry eye syndrome and hormone replacement therapy in postmenopausal women. J Korean Ophthalmol Soc. 2004; 45:552–6.
10. Lee HB, Rhee SW. Tear film break up time in normal Korean. J Korean Ophthalmol Soc. 1981; 22:729–31.
11. Nelson JD, Farris RL. Sodium hyaluronate and polyvinyl alcohol artificial tear preparations. Arch Ophthalmol. 1988; 106:484–7.
crossref
12. Kramer P, Lubkin V, Potter W, et al. Cyclic changes in conjunctival smears from menstruating females. Ophthalmology. 1990; 97:303–7.
crossref
13. Farris RL, Gilbard JP, Stuchell RN, Mandel ID. Diagnostic test in keratoconjunctivitis sicca. CLAO J. 1983; 9:23–8.
14. Lucca JA, Nunez JN, Farris RL. A comparison of diagnostic tests for keratoconjunctivitis sicca: lactoplate, Schirmer, and tear osmolarity. CLAO J. 1990; 16:109–12.
15. Vavilis D, Agorastos T, Vakiani M, et al. The effect of transdermal estradiol on the conjunctiva in postmenopausal women. Eur J Obstet Gynecol Reprod Biol. 1997; 72:93–6.
crossref
16. Clinch TE, Benedetto DA, Felberg NT, et al. Schimer test: a closer look. Arch Ophthalmol. 1983; 101:1383–6.

Table 1.
Symptoms of dry eye and symptom score
Symptom Score
1. Dryness 0 (Absent): no abnormal sensation
2. Tearing 1 (Mild): aware of intermittent sensation
3. Injection 2 (Moderate): more frequent but less than constant symptom
4. Sting Sensation 3 (Severe): constant awareness of sensation
5. Visual blurring
6. Eye strain
7. Foreign body sensation
8. Photophobia
9. Itching
10. Headache
Table 2.
Demography of patients
Demography Values
Age (years)
 Mean± SD 50.50±2.54
 Range 44∼56
Menarche age (years)
 Mean± SD 15.44±1.39
 Range 13∼18
Menopause age (years)
 Mean± SD 48.64±2.77
 Range 42∼53
Duration between menopause and HRT* (months)
 Mean± SD 13.17±10.90
 Range 2∼50
Comorbidity
 Diabetes 13 (36.1%)
 Hypertension 8 (22.2%)

* HRT=hormone replacement therapy.

Table 3.
Chief complaints of dry symptom before hormone replacement therapy (N=72)
Dry eye symptom No. of eyes (%)
Eye strain 30 (41)
Dryness 16 (22)
Foreign body sensation 12 (17)
Tearing 6 (8)
Itching 4 (6)
Photophobia 4 (6)
Table 4.
Changes of tear breakup time and Schirmer test before and after hormone replacement therapy in postmenopausal women
Before treatment 1 month after treatment 3 months after treatment p* p†
Tear break up time (sec) 6.04±2.54 7.99±2.43 8.93±2.20 <0.001 <0.001
Schirmer test (mm) 10.90±4.19 11.56±3.86 11.38±3.72 0.039 0.142
Symptom score 2.10±0.79 1.32±0.84 0.88±0.67 <0.001 <0.001
Fluorescein staining score 0.94±0.71 0.42±0.60 0.22±0.42 <0.001 <0.001

* p=difference between before and 1 month after using hormone replacement therapy

† p=difference between before and 3 months after using hormone replacement therapy.

TOOLS
Similar articles