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Low levels of 17-β-oestradiol, oestrone and testosterone correlate with severe evaporative dysfunctional tear syndrome in postmenopausal women: a case–control study
  1. Caterina Gagliano1,2,
  2. Salvatore Caruso3,
  3. Giuseppe Napolitano2,
  4. Giulia Malaguarnera4,
  5. Maria Vittoria Cicinelli2,
  6. Roberta Amato1,2,
  7. Michele Reibaldi1,
  8. Giuseppe Incarbone5,
  9. Claudio Bucolo4,
  10. Filippo Drago4,
  11. Teresio Avitabile1
  1. 1University of Catania, Eye Clinic, Catania, Italy
  2. 2Neurovisual Science Technology (NEST), Catania, Italy
  3. 3Research Group for Sexology, Department of Medical and Surgical Specialties, University of Catania, Catania, Italy
  4. 4Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry, University of Catania, Catania, Italy
  5. 5Eidgenössische Technische Hochschule (ETH), Zürich, Switzerland
  1. Correspondence to Dr Caterina Gagliano, Neurovisual Science Technology (NEST), Via Tomaselli, Catania 43-95124, Italy; caterinagagliano{at}


Aims To evaluate the role of 17-β-oestradiol, oestrone and total testosterone (TT) deficiency in the pathogenesis of severe evaporative dry eye syndrome (DES), investigating the relationship between tear osmolarity, tear film break-up time (TF-BUT), Schirmer test and serum sex hormones in postmenopausal women.

Methods 44 postmenopausal women were recruited for a case–control study: 22 women with severe evaporative DES (Group A) and 22 without DES (Group B). The tests performed included laboratory blood analysis: fasting plasma profile (17-β-oestradiol, oestrone and TT), glucose level and lipid profile. Detailed eye examinations, including corneal and conjunctival staining, tear osmolarity measurement, tear volume and TF-BUT, were performed. The Ocular Surface Disease Index Questionnaire was also administered.

Results Values of Schirmer test and TF-BUT in Group A were significantly lower in comparison with Group B (p<0.001). Serum levels of 17-β-oestradiol, oestrone and TT were significantly lower in Group A compared with Group B (p<0.05). In women with severe evaporative DES, the levels of 17-β-oestradiol, oestrone and TT were inversely correlated with the tear film osmolarity (r=−0.7, −0.88, −0.81, respectively).

Conclusions In postmenopausal women with severe evaporative DES, sex hormone levels are lower than control and that tear osmolarity is negatively correlated with sex hormone levels.

  • Ocular surface
  • Tears
  • Diagnostic tests/Investigation
  • Pharmacology
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