Dry eye disease symptoms and quality of life in peri- and postmenopausal women
14 February 2022
Summary
The dry eye disease (DED) is a tear production disorder caused by a variety of factors, with dry eyes as the main symptom, and accompanied by binocular itching, foreign body sensation, burning sensation, or photophobia, blurred vision, and other manifestations. Severe symptoms of the DED can mainly affect the patient's visual function, resulting in decreased daily activities and poorer quality of life. Recently, Garcia-Alfaro et al [1] published the results of an observational study which was performed in a group of 1,947 peri- and postmenopausal women. It was found that the prevalence of dry eye symptoms was high in both peri- and postmenopausal women, and the prevalence of dry eye symptoms and Ocular Surface Disease Index (OSDI) scores were higher in postmenopausal women than in perimenopausal ones. The severity of DED symptoms increased with age and decreased with postponement of age at menopause. These findings suggest that menopausal status may be associated with the prevalence and severity of DED symptoms in women. During the menopausal transition and postmenopausal period, hormone levels change, and estrogen and androgen synthesis are reduced, which can cause lacrimal gland and meibomian gland dysfunction, which leads to tear deficiency, tear lipid deficiency, and changes in the kerato-conjunctiva, resulting in the higher prevalence of DED symptoms. Considering that female sex is an important risk factor for eye dryness, the objective data provided by the OSDI questionnaire and ocular examination supports early diagnosis of DED in peri- and postmenopausal women. Menopausal hormone therapy or other related treatments should be given opportunely, thus the DED can be successfully managed, and female quality of life be improved.
Commentary
With the improvement of economic conditions, people are increasingly pursuing a better quality of life and women start to pay more attention to menopausal related symptoms and other conditions, such as the genitourinary syndrome of menopause, quality of sexual life and also DED symptoms, which can currently cause impairment of visual performance and subsequently an economic burden, inducing serious impairment of quality of life.
As discussed above, the DED seriously affects the quality of life of postmenopausal women, but it can easily be ignored by gynecologists. Indeed, because gynecologists are more likely to pay attention to the traditional menopausal symptoms, such as hot flashes, sweating and mood changes, and overlook the discomfort caused by the DED. In fact, both doctors and menopausal women themselves may think that this disease may not be related to the climacteric or be observed among the classical menopausal symptoms. Since menopausal women visit gynecologists more frequently than their ophthalmologists, the gynecologists may have a better chance to perform the initial diagnose of DED based on the symptoms and related questionnaires, such as the OSDI, and then make a further ophthalmical referral.
In summary, the commented study suggests that ovarian hormone production may have a protective effect on the DED [1], so the gynecologist may play an irreplaceable role in providing therapy. Despite this, relevant meta-analyses and clinical trials show that menopausal hormone therapy may have a controversial role in the management of postmenopausal women with DED [5,6], which may be attributed to the estrogen dosage and age when the therapy is initiated. Some studies have pointed out that menopausal hormone therapy seems to have a beneficial effect on lachrymal secretion and the effect is age-dependent [7]. Therefore, women may get more benefits if starting treatment earlier, before estrogen and progesterone levels have reached the lowest. In addition, the effect may be related to the different forms of used hormones. In this sense, estradiol eye drops can reduce moderate-to-severe signs and symptoms of the DED among postmenopausal women [8], despite the lack of large-scale randomized controlled trials. The commented study also indicates that with prolonged life expectancy, estrogen deficiency affects women’s quality of life much more than we can imagine. Hence, doctors should be aware of any subtle symptoms among menopausal women, even if they are not included among the traditional menopausal symptoms. In this sense, the management of the menopause is critically important.
Xiaohan Chen
Qi Yu
Peking Union Medical College Hospital
Beijing, People’s Republic of China
References
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