Abstract
This review examines the etiology and pathophysiology of dry eye disease in postmenopausal women and describes the steroid reproductive hormone influences that may contribute to its development. We have reviewed the relevant studies on dry eye disease related to hormonal status and hormone therapy (HT) in both animal models and humans. Although both low and high estrogen levels have been associated with symptoms of dry eye disease, low androgen levels are a more consistent factor in its etiology. Postmenopausal HT with estrogen or estrogen plus progestogen has shown a limited benefit for dry eye symptoms and may even result in progression of Meibomian gland dysfunction, decreased tear film breaks up time, and tear flow reduction. However, systemic or local androgen treatment has shown promising results in improving dry eye symptoms. Because of the high incidence of dry eye among postmenopausal women that may be related to the hormonal treatment, we propose that a multidisciplinary approach should be considered between gynecologists and ophthalmologists in management of this disorder.