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Writer's pictureThe CandorVision Blog
Nov 136 min read

Got Dry Eyes? Blame it on the Hormones!

The human body is greatly influenced by hormones. They are like orchestra conductors, coordinating everything from metabolism and energy levels to growth, reproduction, and even the heartbeat! [1] What research increasingly suggest is the importance of hormone balance in dry eye symptoms—a lesser-known, but essential part in maintaining eye moisture and overall comfort.


The Eyes and Hormones

Those who suffer from dry eye symptoms might agree here. Dry eye can be more than a minor nuisance—there may be instances of daily life, work performance, and vision affected by the symptoms to name a few. [2]


The experience can leave many wondering what contributes to dry eye symptoms. Surrounding environment and certain medications are well-known causes of dry eye symptoms. [2] Could internal changes be a main driver here, especially in women during their key life stages such as a pregnancy or menopause?


Hormones in our body look after two main glands of the eye: meibomian glands that make up the oily layer and lacrimal glands for the watery part of the tear. [3] The oily and watery layers combined form the tear film, ensuring that the eyes do not dry up, to stay lubricated and hydrated. [3] The increase in fluctuation of hormones may disrupt this delicate balance of the tear film and trigger dry eye symptoms.


Of all the hormones in our body, sex hormones—particularly estrogen and androgens—stand out for their roles in overall tear film health.

While there remains lots of research to be done on the topic and the association with dry eye, here is a quick summary.


Estrogens:

Estrogens’ effects on the eyes are particularly interesting. While some studies show that estrogen benefit lacrimal glands to promote the well-being of the tear film, other evidence suggest the opposite. [4, 5] Estrogen may have adverse effects on the meibomian and lacrimal glands and trigger inflammation of the eye surface. [6-8] In alignment with these findings, some studies also support that estrogen administration/treatment may lead to dryness of the eyes. [9] The takeaways? Estrogens’ role in dry eye is complex!


Androgens:

Another sex hormone is androgens. These ‘male hormones’, which are also present in women, may have a more supportive function on the tear glands than estrogen. Androgens help protect the eye surface, reduce inflammation, and encourage lipid production. Its positive influence on both meibomian and lacrimal glands are well-documented. [10-12] Androgen deficiency have been linked to increased dry eye symptoms, attributed to alterations in the meibomian and lacrimal glands. [13, 14]


Homeostasis diagram

Homeostasis—Balance is the key!

Ever heard of homeostasis? The ‘constant internal balance’ is what matters. Hormonal homeostasis keeps the eyes in good health. [15] It’s like a seesaw. If a hormone level is too high or too low, things wouldn’t be quite just right. During certain phases of life, like menopause and pregnancy, the hormonal balance between estrogen and androgen may become vulnerable.


Let’s take a closer look at how these life stages uniquely impact eye health and dry eye symptoms.


Menopause and Pregnancy: How Hormone Shifts Affect Eye Health


Menopause marks a significant decline in both estrogen and androgen levels, interrupting the homeostasis! Previously, low estrogen levels were thought to be the driver of dry eye symptoms in menopausal women with the aforementioned, unclear effects of estrogen on the eyes. More recent evidence has explored the role of androgens. With a sharp drop in androgen levels, the protective effects of androgens are diminished, possibly leading to meibomian and lacrimal gland dysfunction and dry eyes. [16-18]


Two women discussing with each other

In contract, pregnancy represents an opposite dynamic: high hormone levels, especially estrogen. This surge, essential for supporting pregnancy, may lead to inflammation of the cornea and damage meibomian gland cells. [19-21] Simultaneously, androgen levels are decreased by approximately half. [22] Without androgen’s supportive effects on the tear glands, the eyes may be more vulnerable to dry eye symptoms!


Troubleshooting Dry Eye with Lubricating Eye Drops


When experiencing dry eye symptoms that may be related to major life stage changes, like pregnancy or menopause, a health professional may recommend lubricating eye drops. Here is why and how the HYLO® family of preservative-free lubricating eye drops may help.


Preservative-free and phosphate-free HYLO® and HYLO® GEL lubricating eye drops with high-quality Sodium Hyaluronate can provide long-lasting lubrication. This unparalleled HYLO® therapy experience is featured in airless, multi-dose HYLO® bottle technology – one drop at a time! Relieve mild to moderate or severe dry eye symptoms with HYLO® and HYLO® GEL!


HYLO® and HYLO® GEL bottle and box

Heard of the new starter pack sizes with same advantages? HYLO® mini and HYLO® GEL mini (5mL, 150 drops) help to start early and strong! Both HYLO® mini and HYLO® GEL mini can be used while wearing contact lenses and for 6 months after first use/opening. Consider carrying them or leaving them at the office for dry eye relief throughout the day. 



They are available at pharmacies Canada-wide, behind the counter, without prescription and at select optometry and ophthalmology clinics. 


Feel the Difference with HYLO® mini and HYLO® GEL mini today!


Should you have any concerns about your health or eye health, please consult with your health professional for medical assistance.


CandorVision™ — Your eyes are everything!


References:

  1. Campbell M, Jialal I. National Center for Biotechnology Information [Internet]. Physiology, Endocrine Hormones - StatPearls - NCBI Bookshelf; [cited 2024 Oct 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538498/.

  2. Craig JP, Nelson JD, Azar DT, Belmonte C, Bron AJ, Chauhan SK, de Paiva CS, Gomes JAP, Hammitt KM, Jones L, Nichols JJ, Nichols KK, Novack GD, Stapleton FJ, Willcox MDP, Wolffsohn JS, Sullivan DA. TFOS DEWS II Report Executive Summary. Ocul Surf. 2017 Oct;15(4):802-812. doi: 10.1016/j.jtos.2017.08.003. Epub 2017 Aug 8. PMID: 28797892.

  3. Bron AJ, de Paiva CS, Chauhan SK, Bonini S, Gabison EE, Jain S, Knop E, Markoulli M, Ogawa Y, Perez V, Uchino Y, Yokoi N, Zoukhri D, Sullivan DA. TFOS DEWS II pathophysiology report. Ocul Surf. 2017 Jul;15(3):438-510. doi: 10.1016/j.jtos.2017.05.011. Epub 2017 Jul 20. Erratum in: Ocul Surf. 2019 Oct;17(4):842. doi: 10.1016/j.jtos.2019.08.007. PMID: 28736340.

  4. Azzarolo AM, Eihausen H, Schechter J. Estrogen prevention of lacrimal gland cell death and lymphocytic infiltration. Exp Eye Res. 2003 Sep;77(3):347-54. doi: 10.1016/s0014-4835(03)00120-9. PMID: 12907167.

  5. Ishimaru N, Saegusa K, Yanagi K, Haneji N, Saito I, Hayashi Y. Estrogen deficiency accelerates autoimmune exocrinopathy in murine Sjögren's syndrome through fas-mediated apoptosis. Am J Pathol. 1999 Jul;155(1):173-81. doi: 10.1016/S0002-9440(10)65111-5. PMID: 10393849; PMCID: PMC1866653.

  6. Suzuki T, Schirra F, Richards SM, Jensen RV, Sullivan DA. Estrogen and progesterone control of gene expression in the mouse meibomian gland. Invest Ophthalmol Vis Sci. 2008 May;49(5):1797-808. doi: 10.1167/iovs.07-1458. PMID: 18436814.

  7. Nuzzi R, Caselgrandi P. Sex Hormones and Their Effects on Ocular Disorders and Pathophysiology: Current Aspects and Our Experience. Int J Mol Sci. 2022 Mar 17;23(6):3269. doi: 10.3390/ijms23063269. PMID: 35328690; PMCID: PMC8949880.

  8. Zylberberg C, Seamon V, Ponomareva O, Vellala K, Deighan M, Azzarolo AM. Estrogen up-regulation of metalloproteinase-2 and-9 expression in rabbit lacrimal glands. Experimental eye research. 2007 May 1;84(5):960-72.

  9. Schaumberg DA, Buring JE, Sullivan DA, Dana MR. Hormone replacement therapy and dry eye syndrome. JAMA. 2001 Nov 7;286(17):2114-9. doi: 10.1001/jama.286.17.2114. PMID: 11694152.

  10. Krenzer KL, Dana MR, Ullman MD, Cermak JM, Tolls DB, Evans JE, Sullivan DA. Effect of androgen deficiency on the human meibomian gland and ocular surface. J Clin Endocrinol Metab. 2000 Dec;85(12):4874-82. doi: 10.1210/jcem.85.12.7072. PMID: 11134156.

  11. Sullivan DA, Sullivan BD, Evans JE, Schirra F, Yamagami H, Liu M, Richards SM, Suzuki T, Schaumberg DA, Sullivan RM, Dana MR. Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye. Ann N Y Acad Sci. 2002 Jun;966:211-22. doi: 10.1111/j.1749-6632.2002.tb04217.x. PMID: 12114274.

  12. Sullivan DA, Wickham LA, Krenzer KL, Rocha EM, Toda I. Aqueous tear deficiency in Sjogren € ’s syndrome: Possible causes and potential treatment. In: Pleyer U, Hartmann C, Sterry W, editors. Oculodermal Diseases - Immunology of Bullous Oculo-Muco-Cutaneous Disorders. Buren, The Netherlands: Aeolus Press; 1997. p. 95e152.

  13. Cermak JM, Krenzer KL, Sullivan RM, Dana MR, Sullivan DA. Is complete androgen insensitivity syndrome associated with alterations in the meibomian gland and ocular surface? Cornea 2003;22:516e21.

  14. Tamer C, Oksuz H, Sogut S. Androgen status of the nonautoimmune dry eye subtypes. Ophthalmic Res 2006;38:280e6

  15. Libretti S, Puckett Y. National Center for Biotechnology Information [Internet]. Physiology, Homeostasis - StatPearls - NCBI Bookshelf; [cited 2024 Oct 28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559138/.

  16. Shifren JL, Davis SR. Androgens in postmenopausal women: a review. Menopause. 2017 Aug;24(8):970-979. doi: 10.1097/GME.0000000000000903. PMID: 28609390.

  17. Warren DW, Azzarolo AM, Huang ZM, Platler BW, Kaswan RL, Gentschein E, et al. Androgen support of lacrimal gland function in the female rabbit. Adv Exp Med Biol 1998;438:89e93.

  18. Gagliano C, Caruso S, Napolitano G, Malaguarnera G, Cicinelli MV, Amato R, Reibaldi M, Incarbone G, Bucolo C, Drago F, Avitabile T. Low levels of 17-β-oestradiol, oestrone and testosterone correlate with severe evaporative dysfunctional tear syndrome in postmenopausal women: a case-control study. Br J Ophthalmol. 2014 Mar;98(3):371-6. doi: 10.1136/bjophthalmol-2012-302705. Epub 2014 Jan 3. PMID: 24390165.

  19. Suzuki T, Sullivan DA. Estrogen stimulation of proinflammatory cytokine and matrix metalloproteinase gene expression in human corneal epithelial cells. Cornea. 2005 Nov;24(8):1004-9. doi: 10.1097/01.ico.0000160973.04072.a5. PMID: 16227852.

  20. Song X, Zhao P, Wang G, Zhao X. The effects of estrogen and androgen on tear secretion and matrix metalloproteinase-2 expression in lacrimal glands of ovariectomized rats. Invest Ophthalmol Vis Sci. 2014 Feb 4;55(2):745-51. doi: 10.1167/iovs.12-10457. PMID: 24334444.

  21. Suzuki T, Schirra F, Richards SM, Jensen RV, Sullivan DA. Estrogen and progesterone control of gene expression in the mouse meibomian gland. Invest Ophthalmol Vis Sci. 2008 May;49(5):1797-808. doi: 10.1167/iovs.07-1458. PMID: 18436814.

  22. Ataei Y, Randolph J. Ocular Changes in Pregnancy [Internet]. American Academy of Ophthalmology. [cited 2024Oct.31]. https://www.aao.org/eyenet/article/ocular-changes-in-pregnancy

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