Ocular surface changes over the menstrual cycle in women with and without dry eye.
OBJECTIVE
To analyze whether dry eye symptoms and ocular surface parameters change during different phases of the menstrual cycle.


METHODS
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.


CONCLUSIONS
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.
Versura
Piera
P
Department of Surgical Science and Transplants, Section of Ophthalmology, Alma Mater Studiorum Università di Bologna, Bologna, Italy. piera.versura@unibo.it
Fresina
Michela
M
Campos
Emilio C
EC
D000328:Adult; D016022:Case-Control Studies; D015352:Dry Eye Syndromes / Q000503:physiopathology*; D004967:Estrogens / Q000502:physiology; D005260:Female; D005498:Follicular Phase / Q000502:physiology*; D006801:Humans; D011293:Premenstrual Syndrome
D004967:Estrogens