Hormone replacement therapy and dry eye syndrome. Schaumberg DA, Buring JE, Sullivan DA, Dana MR. JAMA 2001;286:2114–2119.

Abstract

Postmenopausal hormone replacement (HRT) use is common in the United States, resulting in improvement in a variety of menopausal symptoms. Some research suggests that estrogen may have detrimental effects on the tear film and could influence the development of dry eye syndrome. The Women’s Health Study is a large cohort study in which 25,665 postmenopausal women provided information about the use of HRT at baseline (1992), 12, and 36 months. At 48 months, questions were included to assess dry eye syndrome. Three main outcome measures were defined: (1) clinically diagnosed dry eye syndrome, as reported by participants; (2) severe symptoms (both ocular dryness and irritation either constantly or often); and (3) either clinically diagnosed dry eye syndrome or severe symptoms, compared between women who used HRT and those who did not. For the combined end point of either clinically diagnosed dry eye syndrome or severe symptoms, the multivariable-adjusted odds ratios were 1.69 (95% confidence interval [CI], 1.49–1.91) for estrogen use alone and 1.29 (95% CI, 1.13–1.48) for estrogen plus progesterone/progestin use compared with no HRT use. Each 3-year increase in the duration of HRT use was associated with a significant 15% (95% CI, 11%–19%) elevation in risk of clinically diagnosed dry eye syndrome or severe symptoms. Results were similar for the combined end point of clinically diagnosed dry eye syndrome and severe symptoms. These data suggest that women who use HRT, particularly estrogen alone, are at increased risk of dry eye syndrome. Ophthalmologists caring for women who are taking or considering HRT should be aware of this potential complication.—Nancy J. Newman