Does endogenous serum oestrogen play a role in meibomian gland dysfunction in postmenopausal women with dry eye?

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 17 beta-oestradiol (E2), 3-alpha-androstanediol-glucuronide (3 alpha-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, 3a-diol-G and DHEA-S was 9.02 +/- 13.40 pg/mL, 1.59 +/- 1.02 ng/mL and 0.74 +/- 0.53 +/- g/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, R(2)adj=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-Sjogren's dry eye in postmenopausal women.