Sex Hormones Related Ocular Dryness in Breast Cancer Women

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.

AS-OCT and Ocular Hygrometer as Innovative Tools in Dry Eye Disease Diagnosis

“…The ocular surface system [13] is a complex morphofunctional unit made of different tissues, such as conjunctiva, cornea, lids and lacrimal glands, and also a complex network of nerves [61,62], hormones [11], immune cells [63] and metabolites [64] that interplay mainly in the tear film [12,65], which acts as the blood flow in the other tissues. Therefore, the status of the tear film is a reflection on the ocular surface system function.…”

“…DED is classified into two subtypes defined by the underlying mechanism of the disease: aqueous deficiency DED, with inadequate tear production from the lacrimal gland, and evaporative DED, where the function of the meibomian glands is typically compromised [1,7,8]. Dry eye disease is induced by many factors, including age, gender, levels of certain hormones, autoimmune disorders, local environmental conditions, contact lens wear and exposure to some medications [2,[9][10][11].…”

Sex Hormones and Their Effects on Ocular Disorders and Pathophysiology: Current Aspects and Our Experience

“…Although the meibomian glands possess receptors for both estrogen and androgen, it is the latter that are of fundamental importance in determining the quantity and quality of tear production [ 46 ].…”

Pathogenesis of the Homeostatic Failure of Ocular Surface as Morpho-Functional Unit

“…A healthy immune system should initiate an effective parainflammatory response and control it [ 3 ]. In fact, such modulated and self-controlled immune innate parainflammatory response allows an ocular immuno and angiogenic privileged environment [ 4 ], in which inflammation resolves not merely because of the absence of pro-inflammatory signals, but rather by active inhibition pathways [ 5 ]; thus, regulating parainflammation is an active phenomenon simultaneously managed by nervous, endocrine, immune and vascular system [ 6 , 7 , 8 , 9 ]. Therefore, parainflammation is beneficial and dysregulated parainflammation is detrimental.…”

“…Thus, these women after breast surgery experience a severe chronic evaporative dry eye syndrome with mucus filaments and frequent intolerance to wearing contact lenses. Most of them suffer from moderate itching associated with the usual ocular discomfort caused by the dryness [ 7 ].…”