title: Does endogenous serum oestrogen play a role in meibomian gland dysfunction in postmenopausal women with dry eye?
abstract: To explore the relationship between serum concentration of sex hormones and dry eye symptoms and signs in postmenopausal women.
  
  
  
  A cross-sectional analysis was undertaken. Subjects were 46 postmenopausal women with dry eye (mean age 64.4±5.2 years, 13.7±6.4 years since menopause; not undergoing hormone replacement therapy). Ocular symptoms (Ocular Surface Disease Index (OSDI) and Ocular Comfort Index (OCI)), tear function (tear osmolarity, non-invasive tear break-up time, tear secretion), corneal and conjunctival staining, and meibomian gland (MG) appearance, were recorded. Venous blood was collected and serum concentrations of 17β-oestradiol (E2), 3-α-androstanediol-glucuronide (3α-diol-G), and dehydroepiandrosterone sulfate (DHEA-S) were determined using ELISA. Multiple linear regression analysis was used to examine predictors of dry eye symptoms and signs.
  
  
  
  Mean serum concentration of E2, 3α-diol-G and DHEA-S was 9.02±13.40 pg/mL, 1.59±1.02 ng/mL and 0.74±0.53 μg/mL, respectively. Ocular symptoms were elevated (mean scores 27.0±18.1 (OSDI) and 40.3±8.4 (OCI)) but signs were within normal ranges. Higher serum E2 concentration along with capped glands, lid telangiectasia and older age was a significant predictor of worse MG secretion quality (p<0.001, R2adj=0.75). Serum hormones were not significant predictors of ocular symptoms in multivariate analysis (p>0.05).
  
  
  
  Serum oestrogen appears to be a key factor in MG signs. Although serum hormone levels did not contribute significantly to dry eye symptoms in this study, it is possible that oestrogen plays a role through its effect on meibum secretion. These findings suggest that MG dysfunction underpins dry eye symptoms in non-Sjögren's dry eye in postmenopausal women.
  
  
  
  ACTRN12612000281897.
authors.affiliation: School of Optometry & Vision Science, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: Blanka
authors.initials: B
authors.lastname: Golebiowski
authors.affiliation: School of Optometry & Vision Science, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: Noor
authors.initials: N
authors.lastname: Badarudin
authors.affiliation: Sydney Menopause Centre, Royal Hospital for Women, Randwick, New South Wales, Australia.|School of Womens' and Childrens' Health, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Eden
authors.affiliation: School of Optometry & Vision Science, UNSW Australia, Sydney, New South Wales, Australia.|Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Jingjing
authors.initials: J
authors.lastname: You
authors.affiliation: School of Optometry & Vision Science, UNSW Australia, Sydney, New South Wales, Australia.|Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Hampel
authors.affiliation: School of Optometry & Vision Science, UNSW Australia, Sydney, New South Wales, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Stapleton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000473:pathology; D003430:Cross-Sectional Studies; D015352:Dry Eye Syndromes / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology*; D004797:Enzyme-Linked Immunosorbent Assay; D004967:Estrogens / Q000097:blood*; D005260:Female; D006801:Humans; D008537:Meibomian Glands / Q000503:physiopathology*; D008875:Middle Aged; D017698:Postmenopause; D012044:Regression Analysis; D013666:Tears / Q000378:metabolism
chemical_list: D004967:Estrogens
keywords: Eye Lids; Ocular surface; Tears