Hormones and Dry Eye Syndrome

An Update on What We Do and Don't Know

Eduardo Melani Roch; Flavio Mantelli, Luis Fernando Nominato; Stefano Bonini


Curr Opin Ophthalmol. 2013;24(4):348-355. 

In This Article

Abstract and Introduction


Purpose of review Dry eye syndrome (DES) prevalence is large and its relationship with hormonal diseases is becoming clearer, although more complex. This review provides insight to this association as well as clarifying what remains unanswered about how to interpret and treat findings common to both DES and hormonal diseases.

Recent findings Several sex hormone-related diseases are associated with DES. Hormone replacement therapy to correct such conditions has conflicting outcomes based on epidemiologic studies and clinical trials. Thyroid-associated diseases are frequently involved in DES and must be investigated in cases where the cause of the ocular disease is undetermined. Diabetes mellitus is one of the major causes of DES, whereas correcting the metabolic imbalance minimizes its ocular symptomology. Gene therapy to treat DES-related hormonal diseases is a promising option based on animal studies.

Summary Diagnosis and management of hormonal diseases can minimize the ocular surface damage and severity of DES. Clinical care of DES includes patient evaluation of hormonal status. Future research requires clarification of the underlying disease mechanisms and identifying novel strategies to reprogram the endocrine system rather than chronic medication usage.


As early as 1930, Dr Henrik Sjögren indicated that there is an association between hormonal changes and dry eye syndrome (DES).[1] His first study mentioned the disease only in women and had one patient with glucose tolerance test results reflective of an insulin resistance. Since then, numerous other results confirmed an association between endocrine system balance, ocular surface homeostasis and lacrimal gland function.[2] Moreover, the role of hormonal diseases in DES progression is now more extensively described providing novel perspectives for hormonal treatment of this condition.

Currently, it is apparent that in several different diseases caused by a hormonal imbalance, DES clinical findings occur (Table 1).

This review analyzes recent controversy surrounding the relationship among menopause changes and DES. It focuses also on the association between DES and the most common endocrine diseases involving changes in sex hormones, thyroid-associated diseases, and diabetes mellitus. A complementary topic describes the potential use of gene therapy to reprogram lacrimal gland function so as to overcome hormonal disease-induced ocular surface damage.