Original article
Itchy-Dry Eye Associated with Polycystic Ovary Syndrome

https://doi.org/10.1016/j.ajo.2007.01.030Get rights and content

Purpose

The authors aimed to define the ocular symptomatology of women with polycystic ovaries and hyperandrogenism.

Design

Prospective, observational case series.

Methods

Of the 62 consecutive patients with an ultrasonographic diagnosis of polycystic ovary (PCO), 16 were identified as having clinical and biochemical signs of hyperandrogenism. All women with a history of ocular symptoms (20/62 total patients [32.3%], 15/16 polycystic ovary syndrome (PCOS) patients [93.7%], and 5/46 PCO patients [10.8%]) underwent a complete eye examination with conjunctival impression cytologic sampling. Clinical measurements of tear function (tear film break-up time [BUT], Schirmer I test) were completed along with analysis of conjunctival goblet cell number, conjunctival immunostaining, and reverse-transcriptase polymerase chain reaction for the mucins MUC1 and MUC5AC. Clinical, histologic, and biochemical data of patients with PCOS were compared statistically with that of patients with PCO and with eight age- and gender-matched healthy controls. Eight of the most severely affected patients received systemic antiandrogen therapy and underwent further ocular evaluation four months after systemic therapy.

Results

Women with PCOS had greater conjunctival hyperemia (P < .001), dryness (P < .001), itching (P < .001), mucous discharge (P < .001), and contact lens intolerance (P < .001) than patients with PCO. Patients with PCOS had a significant reduction of the tear film BUT accompanied by a significant increase in goblet cell number and conjunctival MUC5AC messenger ribonucleic acid expression compared with both PCO patients and healthy subjects.

Conclusions

Evaluation of the ocular surface should be considered in patients with PCO or PCOS. Women with PCOS were more likely to have itchy-dry eyes, decreased tear film BUT, and increased goblet cell density.

Section snippets

Study Protocol

This study was carried out with approval from the Institutional Review Board and the intramural committee. Written informed consent was obtained from all subjects. From March 2005 through March 2006, we evaluated 62 consecutive women (mean age ± standard deviation, 25.4 to 5.27 years) with a diagnosis of polycystic ovaries detected by ultrasonography. The presence of ocular symptoms (dryness, itching, tearing, hyperemia, burning, foreign body sensation, photophobia, and secretion/mucous

Results

Sixteen of 62 patients were diagnosed with PCOS according to the Rotterdam 2003 criteria, whereas the remaining 46 patients were diagnosed with echographic evidence of PCO only without clinical or biochemical evidence of hyperandrogenism.

Twenty (32.3%) of 62 PCO/PCOS patients had bilateral ocular signs and symptoms at presentation: 15 of the 16 women with PCOS (93.7%) and five of the 46 PCO patients (10.8%). These symptoms manifested approximately three years (mean, 38 ± 23 months) after the

Discussion

We describe the presence of conjunctival hyperemia, follicular reaction, mucus hypersecretion, and occasional superficial punctate keratopathy associated with itching, dryness, contact lens intolerance, and foreign body sensation in 94% of young women with PCOS. In these patients, ocular signs and symptoms were manifested approximately three years after the first ultrasonographic finding of PCO.

These signs and symptoms could be ascribed to two distinct entities, ocular allergy and dry eye, yet

Stefano Bonini, MD, is a Professor and Chairman of the Department of Ophthalmology at the University of Rome “Campus Bio-Medico”, since 2002. He received his medical degree from University of Rome where he completed his residency program in Ophthalmology and in Allergology and Clinical Immunology. Dr Bonini then completed a three year research fellowship at the Schepens Eye Research Institute in Boston, Massachusetts, where he was trained by Dr Mathea R. Allansmith in Ocular Allergy.

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    Stefano Bonini, MD, is a Professor and Chairman of the Department of Ophthalmology at the University of Rome “Campus Bio-Medico”, since 2002. He received his medical degree from University of Rome where he completed his residency program in Ophthalmology and in Allergology and Clinical Immunology. Dr Bonini then completed a three year research fellowship at the Schepens Eye Research Institute in Boston, Massachusetts, where he was trained by Dr Mathea R. Allansmith in Ocular Allergy.

    Alessandro Lambiase, MD, PhD, is an Assistant Professor at the Department of Ophthalmology of the University of Rome “Campus Bio-Medico”. He received his medical degree from University of Rome “Tor Vergata” where he completed his residency program in Ophthalmology and his PhD program in Advanced Technology in Bio-Medicine. Dr Lambiase completed a five year research fellowship at the Institute of Neurobiology of the National Research Institute where he was trained by the Nobel Prize Professor Rita Levi-Montalcini.

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