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Galor A, Britten-Jones AC, Feng Y, Ferrari G, Goldblum D, Gupta PK, Merayo-Lloves J, Na KS, Naroo SA, Nichols KK, Rocha EM, Tong L, Wang MTM, Craig JP. TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface. Ocul Surf 2023; 28:262-303. [PMID: 37054911 DOI: 10.1016/j.jtos.2023.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.
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Affiliation(s)
- Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Surgical Services, Miami Veterans Administration, Miami, FL, USA.
| | - Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Yun Feng
- Department of Ophthalmology, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Giulio Ferrari
- Cornea and Ocular Surface Unit, Eye Repair Lab, San Raffaele Scientific Institute, Milan, Italy
| | - David Goldblum
- Pallas-Kliniken, Olten, Bern, Zurich, Switzerland; University of Basel, Basel, Switzerland
| | - Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC, USA; Department of Ophthalmology, Tulane University, New Orleans, LA, USA
| | - Jesus Merayo-Lloves
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo, Principality of Asturias, Spain
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eduardo M Rocha
- Department of Ophthalmology, Othorynolaringology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Ocular Surface Research Group, Singapore Eye Research Institute, Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Acet Y, Sarikaya S. Another Etiological Factor of Meibomian Gland Loss in Patients with Polycystic Ovary Syndrome: Inflammation. J Ocul Pharmacol Ther 2022; 38:626-634. [PMID: 36178938 DOI: 10.1089/jop.2022.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this prospective study was to compare the tear film pattern, meibomian gland (MG) losses in patients with polycystic ovary syndrome (PCOS) and healthy individuals in the control group, and to examine the correlation between peripheral blood values and findings in patients with PCOS. Methods: Eighty-one eyes of 81 patients with PCOS and 78 eyes of 78 healthy individuals were included in this study. Mean noninvasive first tear film break-up time (NIF-BUT) values and the mean noninvasive average tear film break-up time (NIAvg-BUT) values of all breaking-up occurring in the test were compared. MG losses were compared between the groups. In the second step of this study, we examined the correlation between NIF-BUT and NIAvg-BUT values and MG losses with inflammatory parameters. Results: NIF-BUT values were 7.21 ± 5.75 and 10.18 ± 5.90 s, respectively, in PCOS and control groups (P = 0.001). Loss of MG in the upper eyelids (SM-SCL) of PCOS and control group was 39.81 ± 16.34 and 17.84 ± 9.48, respectively (P = 0.000). Positive correlation was detected between SM-SCL value and neutrophil/lymphocyte ratio; platelet/lymphocyte ratio (P/L); and systemic immune-inflammation index, the value obtained from platelet count × (neutrophil/lymphocyte). Conclusion: Increased tear film instability and increased MG loss rates were detected in PCOS patients. In addition, we found a positive correlation between MG losses and inflammatory indices of patients with PCOS. We think that inflammatory processes also provide an additive effect, in addition to hormonal changes on the physiopathological process on the ocular surface in patients with PCOS.
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Affiliation(s)
- Yakup Acet
- Department of Ophthalmology and Mardin Training and Research Hospital, Mardin, Turkey
| | - Sevcan Sarikaya
- Department of Gynecology and Obstetrics, Mardin Training and Research Hospital, Mardin, Turkey
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Tear film impairment and meibomian gland loss in patients with polycystic ovary syndrome. Int Ophthalmol 2022; 43:795-805. [PMID: 36053477 DOI: 10.1007/s10792-022-02479-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of this prospective study is to comparatively assess the tear film, meibomian gland (MG), cornea and anterior chamber parameters and also subjective ocular complaints in patients with polycystic ovary syndrome (PCOS) and healthy control subjects. MATERIALS AND METHODS We included 53 eyes of the 53 patients diagnosed with PCOS and 57 eyes of the 57 healthy control subjects (who are non-pregnant, none of the following clinical findings of male pattern hair loss, hirsutism or acne and with regular menstrual cycles, who have no laboratory findings in her medical history that indicate hyperandrogenism, and who have ovaries that appear to be normal ultrasonographically. All subjects were referred to the masked ophthalmologist by the obstetrician and gynecologist. Participants underwent evaluation of the non-invasive tear film break-up time test (NI-BUT); loss of MGs by non-contact meibography, evaluation of cornea and anterior chamber parameters, and evaluation of subjective ocular complaints using the ocular surface disease index (OSDI). RESULTS The mean age of PCOS group and controls was 25.08 ± 4.88 and 25.44 ± 5.00 years, respectively. There was no statistically significant difference between the PCOS and control groups in terms of age (p = 0.732). Mean non-invasive first tear film breakup times (NIF-BUT) values of PCOS group and controls were 6.15 ± 4.99 and 10.48 ± 5.81 s, and mean non-invasive average tear film breakup times (NIAvg-BUT) values of PCOS group and controls were 8.48 ± 4.27 and 11.94 ± 4.64 s, respectively; both cases refer to a significant difference between the groups (p = 0.000). In PCOS group, loss of MG in the upper lids was 40.21%, in the lower lids was 53.45%; on the other hand, in control group 15.76% and 21.47%, respectively; both cases refer to a significant difference between the groups (p = 0.000). The number of patients with abnormal OSDI scores (scores ≥ 13 points) was significantly higher in PCOS group (54.7%) than in controls (19.3%) (p = 0.000). Anterior chamber volume (ACV) measured by the topography device in PCOS group was significantly lower (156.5 and 167.4) (p = 0.024). CONCLUSION Findings of this study indicated that tear film stability impaired in patients with PCOS and that this impairment was accompanied by the loss of MG, which play a key role in tear film stability.
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Kundu G, Shetty R. Commentary: Evaluation of meibomian gland morphology and anterior segment parameters by Sirius topography systems in polycystic ovary syndrome. Indian J Ophthalmol 2022; 70:2928-2929. [PMID: 35918945 DOI: 10.4103/ijo.ijo_960_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
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Yücekul B, Gürlek B. Non-invasive evaluation of meibomian gland morphology and tear film and anterior segment parameters in women with polycystic ovarian syndrome. Photodiagnosis Photodyn Ther 2021; 37:102654. [PMID: 34844002 DOI: 10.1016/j.pdpdt.2021.102654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/16/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare the meibomian glands (MG), non-invasive tear film break-up time (NITBUT), and corneal and anterior segment measurements in patients with polycystic ovary syndrome and healthy women. METHODS The study included 66 polycystic ovarian syndrome (PCOS) patients and 42 healthy volunteers aged 18-35 years. The first and average NITBUT, MG loss, mean keratometry (Km), central (CCT) and thinnest (TCT) corneal thicknesses, anterior chamber depth (ACD), anterior chamber volume (ACV), irido-corneal angle (ICA), corneal volume (CV) and Ocular Surface Disease Index (OSDI) results were analyzed. RESULTS The mean MG loss values were 29.9 ± 11.9 and 20.8 ± 11.0 in the PCOS and control groups, respectively (p < 0.001). MG loss (meiboscale ≥ 1) was determined in 64 (96.9%) eyes in the PCOS group and in 36 (85.7%) eyes in the control group. There was no significant difference between the groups in respect of NITBUT, OSDI, Km, CCT, TCT, ACD, ACV, ICA and CV values (p > 0.05, for all). CONCLUSION MG loss is a physiological process which is distinct in PCOS patients, but does not cause tear film alterations. Further studies are needed to show the contributing factors of MGD in PCOS patients.
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Affiliation(s)
- Burcu Yücekul
- Department of Ophthalmology, Haseki Training and Research Hospital, Sultangazi, Istanbul 34265, Turkey.
| | - Beril Gürlek
- Department of Obstetrics and Gynecology, Recep Tayyip Erdogan University Faculty of Medicine, Rize, Turkey
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Association Between Dry Eye and Polycystic Ovary Syndrome: Subclinical Inflammation May Be Part of the Process. Eye Contact Lens 2021; 47:27-31. [PMID: 32496281 DOI: 10.1097/icl.0000000000000716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the changes in tear function in patients with polycystic ovary syndrome (PCOS) and establish whether there is a correlation between hormonal levels, novel hematologic biomarkers, and dry eye parameters. MATERIAL AND METHOD Forty-seven patients with PCOS and 43 age-matched patients with unexplained infertility were included in the control group. Follicle-stimulating hormone, luteinizing hormone, estradiol, thyroid-stimulating hormone, prolactin, dehydroepiandrosterone sulfate (DHEA-S), 17-OH progesterone, fasting and postprandial glucose, fasting insulin, and cholesterol metabolites were evaluated in both groups. In addition, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio were obtained from a complete blood count. The Ocular Surface Disease Index (OSDI) questionnaire was administered, and all patients underwent tear break-up time (BUT) and Schirmer I tests. Bivariate correlations were investigated using Spearman correlation coefficient analysis. RESULTS The mean age of the PCOS group and the control group was 27.66±3.96 years and 29.28±6.83 years, respectively. Schirmer I test scores and BUT values were significantly lower and OSDI results were significantly higher in the PCOS group (P=0.003, P<0.001, and P=0.004). An inverse correlation was found between DHEA-S and BUT values in the PCOS group (r=-0.296, P=0.043). Similarly, a negative correlation was also present between NLR and BUT values in the PCOS group (r=-0.322, P=0.027). CONCLUSIONS Dry eye can be well established by sensitive tests in patients with PCOS. The severity of dry eye may be correlated with the level of inflammation and hyperandrogenism.
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Grasso A, Di Zazzo A, Giannaccare G, Sung J, Inomata T, Shih KC, Micera A, Gaudenzi D, Spelta S, Romeo MA, Orsaria P, Coassin M, Altomare V. Sex Hormones Related Ocular Dryness in Breast Cancer Women. J Clin Med 2021; 10:jcm10122620. [PMID: 34198684 PMCID: PMC8232194 DOI: 10.3390/jcm10122620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Dry eye syndrome (DES) is strictly connected to systemic and topical sex hormones. Breast cancer treatment, the subsequent hormonal therapy, the subsequent hyperandrogenism and the early sudden menopause, may be responsible for ocular surface system failure and its clinical manifestation as dry eye disease. This local dryness is part of the breast cancer iatrogenic dryness, which affects overall mucosal tissue in the fragile population of those with breast cancer. Methods: A literature review regarding the role of sex hormone changes and systemic hormonal replacement treatments (SHRT) in DES available on PubMed and Web of Science was made without any restriction of language. Results: Androgens exert their role on the ocular surface supporting meibomian gland function and exerting a pro-sebaceous effect. Estrogen seems to show a pro/inflammatory role on the ocular surface, while SHRT effects on dry eye are still not well defined, determining apparently contradictory consequences on the ocular surface homeostasis. The role of sex hormones on dry eye pathogenesis is most likely the result of a strict crosstalk between the protective androgens effects and the androgen-modulating effects of estrogens on the meibomian glands. Conclusions: Patients with a pathological or iatrogenic hormonal imbalance, such as in the case of breast cancer, should be assessed for dry eye disease, as well as systemic dryness, in order to restore their social and personal quality of life.
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Affiliation(s)
- Antonella Grasso
- Breast Unit, University Campus Bio-Medico, 00128 Rome, Italy; (A.G.); (P.O.); (V.A.)
| | - Antonio Di Zazzo
- Ophthalmology Operative Complex Unit, University Campus Bio-Medico, 00128 Rome, Italy; (D.G.); (S.S.); (M.C.)
- Correspondence: ; Tel.: +39-06225418893; Fax: +39-9622541456
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy;
| | - Jaemyoung Sung
- Department of Ophthalmology, School of Medicine, Juntendo University, 1130033 Tokyo, Japan; (J.S.); (T.I.)
| | - Takenori Inomata
- Department of Ophthalmology, School of Medicine, Juntendo University, 1130033 Tokyo, Japan; (J.S.); (T.I.)
| | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong;
| | - Alessandra Micera
- Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Sciences, IRCCS–Fondazione Bietti, 00198 Rome, Italy;
| | - Daniele Gaudenzi
- Ophthalmology Operative Complex Unit, University Campus Bio-Medico, 00128 Rome, Italy; (D.G.); (S.S.); (M.C.)
| | - Sara Spelta
- Ophthalmology Operative Complex Unit, University Campus Bio-Medico, 00128 Rome, Italy; (D.G.); (S.S.); (M.C.)
| | | | - Paolo Orsaria
- Breast Unit, University Campus Bio-Medico, 00128 Rome, Italy; (A.G.); (P.O.); (V.A.)
| | - Marco Coassin
- Ophthalmology Operative Complex Unit, University Campus Bio-Medico, 00128 Rome, Italy; (D.G.); (S.S.); (M.C.)
| | - Vittorio Altomare
- Breast Unit, University Campus Bio-Medico, 00128 Rome, Italy; (A.G.); (P.O.); (V.A.)
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Turan M, Turan G, Usta A. Evaluation of the ocular surface by impression cytology in patients with endometriosis. Graefes Arch Clin Exp Ophthalmol 2020; 258:931-937. [PMID: 31897701 DOI: 10.1007/s00417-019-04591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/05/2019] [Accepted: 12/23/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the effect of endometriosis on the ocular surface. METHODS A total of 50 patients were included in the study and divided into two groups. Group 1 consisted of 25 patients with endometriosis. Group 2 had 25 control patients. All patients underwent complete ophthalmic examination, and the right eyes were included in the study. To evaluate the ocular surface, both groups were tested with the following: the Schirmer I test, tear breakup time (TBUT), the conjunctival impression cytology (CIC), and the Ocular Surface Disease Index (OSDI). The results were subsequently compared. RESULTS The average Schirmer I test results were 8.40 ± 2.74 mm in group 1 and were significantly lower in patients with endometriosis (P < 0.001). The average TBUT test results were 9.04 ± 3.61 s in group 1 and were significantly lower in patients with endometriosis (P < 0.001). The average OSDI results were 24.04 ± 9.29 in group 1 and were significantly higher in patients with endometriosis (P < 0.001). The average CIC results were 1.76 ± 0.88 in group 1 and were significantly higher in patients with endometriosis (P < 0.001). CONCLUSIONS Ocular surface changes, including squamous metaplasia, may be observed in the conjunctiva of patients with endometriosis.
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Affiliation(s)
- Meydan Turan
- Department of Ophthalmology, Balikesir Ataturk City Hospital, Balikesir, Turkey.
| | - Gulay Turan
- Faculty of Medicine, Department of Pathology, Balıkesir University, Balıkesir, Turkey
| | - Akin Usta
- Faculty of Medicine, Department of Obstetrics and Gynecology, Balikesir University, Balikesir, Turkey
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Evaluation of changes in meibomian glands in polycystic ovary syndrome by noncontact infrared meibography. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.618249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Baser G, Yildiz N, Calan M. Evaluation of Meibomian Gland Dysfunction in Polycystic Ovary Syndrome and Obesity. Curr Eye Res 2016; 42:661-665. [PMID: 27791408 DOI: 10.1080/02713683.2016.1233985] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose/Aim of the study: The purpose of this study was to evaluate the interaction between Polycystic ovary syndrome (PCOS) and Meibomian gland dysfunction (MGD) and obesity, to reveal whether there is a correlation between the testosterone levels and body-mass index (BMI) levels and the dry-eye complaints of these patients. MATERIAL AND METHODS The study included 92 patients with PCOS and 52 healthy patients from March 2013 to March 2014. All patients underwent a physical examination, pelvic ultrasound, and clinical and biochemical tests, including free testosterone levels to confirm the diagnosis of PCOS. The BMIs of all subjects were recorded. In addition, the presence of posterior blepharitis, as an indicator of MGD, was recorded. All patients underwent the dry-eye tests including Schirmer 1 and tear film break-up time (BUT). Complaints of dry-eye of the patients were evaluated with the ocular surface disease index (OSDI) questionnaire. The scores of both groups were compared. RESULTS The presence of MGD was 72.82% in the PCOS group and 61.53% in the control group. There was no correlation between the testosterone levels and study parameters in both groups. BUT levels negatively correlated with BMI in subjects without PCOS (r = -0.520, p = 0.001), whereas positively correlated with MGD and OSDI scores (r = 0.610, p = 0.632; p = 0.001, p = 0.001; respectively). CONCLUSION Tear film instability due to MGD is common in PCOS and in subjects with high BMI. The MGD in PCOS patients is independent of the BMI.
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Affiliation(s)
- Gonen Baser
- a Ozel Egepol Hospital Eye Clinic , Izmir , Turkey
| | - Nurdan Yildiz
- b Department of Gynecology and Obstetrics , Sifa University Izmir , Turkey
| | - Mehmet Calan
- c Department of Endocrinology , Bozyaka Education and Investigation Hospital, Izmir , Turkey
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Mantelli F, Moretti C, Macchi I, Massaro-Giordano G, Cozzupoli GM, Lambiase A, Bonini S. Effects of Sex Hormones on Ocular Surface Epithelia: Lessons Learned From Polycystic Ovary Syndrome. J Cell Physiol 2015; 231:971-5. [PMID: 26491950 DOI: 10.1002/jcp.25221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/20/2015] [Indexed: 11/08/2022]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality in women of reproductive age. Although its clinical consequences have been known for a long time to extend beyond the reproductive system, with type-2 diabetes and obesity being the most common, the involvement of the ocular surface in PCOS has been described only more recently. The ocular surface is a morphofunctional unit comprising eyelid margin, tear film, cornea, and conjunctiva. Increasing evidence indicates that these structures are under a sex hormone control and relevant diseases such as ocular allergy and dry eye are often caused by alterations in circulating or local steroid hormones levels. Novel treatments targeting sex hormone receptors on ocular surface epithelial cells are also being developed. In this review we aim to describe the current knowledge on the effects of sex hormones at the ocular surface, with a special focus on the effects of androgen imbalance in PCOS.
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Affiliation(s)
- Flavio Mantelli
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania
| | - Costanzo Moretti
- Department of Endocrinology, Tor Vergata University of Rome, Rome, Italy
| | - Ilaria Macchi
- Department of Ophthalmology, Campus Bio-Medico University of Rome, Rome, Italy
| | | | | | | | - Stefano Bonini
- Department of Ophthalmology, Campus Bio-Medico University of Rome, Rome, Italy
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Polycystic ovary syndrome: aggressive or protective factor for the retina? Evaluation of macular thickness and retinal nerve fiber layers using high-definition optical coherence tomography. J Ophthalmol 2015; 2015:193078. [PMID: 25763280 PMCID: PMC4339823 DOI: 10.1155/2015/193078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/17/2015] [Accepted: 01/19/2015] [Indexed: 01/14/2023] Open
Abstract
Objective. To compare macular thickness (MT) and retinal nerve fiber layers (RNFL) between women with polycystic ovary syndrome (PCOS) and healthy women. Materials and Methods. The study included 45 women with PCOS and 47 ovulatory women undergoing clinical-gynecological and ophthalmic evaluations, including measurement of MT, RNFL, and optic disc parameters using optical coherence tomography. Results. The superior RNFL around the optic nerve was significantly thicker in PCOS than in healthy volunteers (P = 0.036). After stratification according to insulin resistance, the temporal inner macula (TIM), the inferior inner macula (IIM), the nasal inner macula (NIM), and the nasal outer macula (NOM) were significantly thicker in PCOS group than in control group (P < 0.05). Both the presence of obesity associated with insulin resistance (P = 0.037) and glucose intolerance (P = 0.001) were associated with significant increase in the PC1 mean score, relative to MT. A significant increase in the PC2 mean score occurred when considering the presence of metabolic syndrome (P < 0.0001). There was a significant interaction between obesity and inflammation in a decreasing mean PC2 score relative to macular RNFL thickness (P = 0.034). Conclusion. Decreased macular RNFL thickness and increased total MT are associated with metabolic abnormalities, while increased RNFL thickness around the optic nerve is associated with hormonal changes inherent in PCOS.
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Truong S, Cole N, Stapleton F, Golebiowski B. Sex hormones and the dry eye. Clin Exp Optom 2014; 97:324-36. [PMID: 24689906 DOI: 10.1111/cxo.12147] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 11/26/2013] [Accepted: 01/19/2014] [Indexed: 01/15/2023] Open
Abstract
The greater prevalence of dry eye in women compared to men suggests that sex hormones may have a role in this condition. This review aims to present evidence for how sex hormones may affect the ocular structures involved in the production, regulation and maintenance of the normal tear film. It is hypothesised that hormone changes alter the homeostasis of the ocular surface and contribute to dry eye. Androgens impact on the structure and function of the meibomian and lacrimal glands and therefore androgen deficiency is, at least in part, associated with the aetiology of dry eye. In contrast, reports of the effects of oestrogen and progesterone on these ocular structures and on the conjunctiva are contradictory and the mechanisms of action of these female-specific sex hormones in the eye are not well understood. The uncertainty of the effects of oestrogen and progesterone on dry eye symptoms is reflected in the controversial relationship between hormone replacement therapy and the signs and symptoms of dry eye. Current understanding of sex hormone influences on the immune system suggests that oestrogen may modulate a cascade of inflammatory events, which underlie dry eye.
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Affiliation(s)
- Susan Truong
- The University of New South Wales, Kensington, New South Wales, Australia
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Gagliano C, Caruso S, Napolitano G, Malaguarnera G, Cicinelli MV, Amato R, Reibaldi M, Incarbone G, Bucolo C, Drago F, Avitabile T. Low levels of 17-β-oestradiol, oestrone and testosterone correlate with severe evaporative dysfunctional tear syndrome in postmenopausal women: a case–control study. Br J Ophthalmol 2014; 98:371-6. [DOI: 10.1136/bjophthalmol-2012-302705] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Retinal nerve fiber layer thickness in women with polycystic ovary syndrome. J Ophthalmol 2013; 2013:752186. [PMID: 24377044 PMCID: PMC3860145 DOI: 10.1155/2013/752186] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/30/2013] [Indexed: 11/17/2022] Open
Abstract
Aim. To compare the retinal nerve fiber layer (RNFL) thickness between women with polycystic ovary syndrome (PCOS) and healthy women. Materials and Methods. The study included 88 eyes of 44 women (group 1) with PCOS and 84 eyes of 42 healthy women (group 2). In all subjects, the RNFL and ganglion cell complex (GCC) thicknesses were measured by optical coherence tomography (OCT). In addition, visual acuity (VA), intraocular pressure (IOP), refractive errors, central macular thickness (CMT), central corneal thickness (CCT), and excavation of optic disc were evaluated in all subjects. Results. Mean values of GCC, IOP, VA, CMT, CCT, and refractive errors were similar between the 2 groups. The average RNFL, superior average RNFL, and inferior average RNFL thicknesses were higher in subjects with PCOS than in healthy subjects (P = 0.003, P = 0.012, and P = 0.009), respectively. Conclusion. The average RNFL, superior average RNFL, and inferior average RNFL thicknesses in women with PCOS were significantly higher than in healthy women.
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Gonen T, Celik C, Oznur M, Abali R, Gonen KA, Horozoglu F, Aksu E, Keskinbora KH. Tear osmolarity and ocular surface changes in patient with polycystic ovary syndrome. Curr Eye Res 2012; 38:621-5. [PMID: 23249394 DOI: 10.3109/02713683.2012.749917] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the tear osmolarity and ocular surface changes in patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS Forty-eight patients with recently diagnosed PCOS and thirty-three control volunteers were enrolled in this prospective, observational study. Ocular surface disease index (OSDI) score was calculated. Tear osmolarity was measured using the TearLab Osmolarity System (Tearlab, San Diego, CA, USA). All subjects also underwent the following ophthalmologic evaluation: Schirmer I test, tear-film breakup time (TBUT), ocular surface flourescein staining, and conjunctival impression cytology. RESULTS Mean OSDI score was significantly higher in patients with PCOS than control subjects (P = 0.001). Tear osmolarity was similar in both groups (P = 0.404). There were no significant differences between groups in Schirmer I test results, TBUT, and ocular surface flourescein staining scores (P > 0.05). Compared to control group, a statistically significant squamous metaplasia was observed in temporal bulbar conjunctival impression cytology specimens in PCOS group (P = 0.032). CONCLUSIONS In patients with recently diagnosed PCOS, tear volume and osmolarity are not affected but, conjunctival morphology may be affected, though on a limited scale.
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Affiliation(s)
- Tansu Gonen
- Namik Kemal University School of Medicine, Department of Ophthalmology, Tekirdag, Turkey.
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Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK. The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci 2011; 52:1994-2005. [PMID: 21450917 DOI: 10.1167/iovs.10-6997e] [Citation(s) in RCA: 379] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Debra A Schaumberg
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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