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Does endogenous serum oestrogen play a role in meibomian gland dysfunction in postmenopausal women with dry eye?
  1. Blanka Golebiowski1,
  2. Noor Badarudin1,
  3. John Eden2,3,
  4. Jingjing You1,4,
  5. Ulrike Hampel1,5,
  6. Fiona Stapleton1
  1. 1School of Optometry & Vision Science, UNSW Australia, Sydney, New South Wales, Australia
  2. 2Sydney Menopause Centre, Royal Hospital for Women, Randwick, New South Wales, Australia
  3. 3School of Womens’ and Childrens’ Health, UNSW Australia, Sydney, New South Wales, Australia
  4. 4Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  5. 5Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
  1. Correspondence to Dr Blanka Golebiowski, School of Optometry and Vision Science, UNSW Australia, Sydney, NSW 2052, Australia; b.golebiowski{at}


Aim To explore the relationship between serum concentration of sex hormones and dry eye symptoms and signs in postmenopausal women.

Methods 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.

Results 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).

Conclusion 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.

Trial registration number ACTRN12612000281897.

  • Ocular surface
  • Tears
  • Eye Lids

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  • Correction notice This article has been corrected since it was published Online First. The address in the Correspondence section has been amended.

  • Contributors BG, JE and FS: conception and design. BG, FS, NB, JY and UH: data collection, analysis and interpretation. BG, FS and JY: drafting the article. All authors: critically revised the manuscript for important intellectual content. BG and FS: final approval of the version to be published. All authors: read and approved the final manuscript.

  • Funding This work was supported by the Faculty of Science Interdisciplinary Research Grants Program, University of New South Wales, 2013.

  • Competing interests None declared.

  • Ethics approval University of New South Wales Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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