The applications of androgen in the treatment of dry eye disease: a systematic review of clinical studies

Abstract

Androgen regulates the function of lacrimal and meibomian glands, and its deficiency is a pathological factor underlying dry eye disease (DED). However, no androgen has been approved for treating DED due to lack of definite evidence regarding its efficacy and safety in clinics. In this systematic review, we have summarized the clinical studies on the safety and efficacy of androgen replacement therapy (ART) for DED. Medline (via Pubmed), Embase, Clinicaltrials.gov, Wanfang and Chinese Clinical Trials Registry Database were searched for the relevant prospective studies, and 7 studies wherein androgen was applied topically via eye drops or systemically via oral or transdermal administration were included. The quality of these studies was assessed with the Cochrane Collaboration's tool for assessing risk of bias and methodological index for non-randomized studies. Most studies showed that androgen effectively improved dry eye-related symptoms and increased tear secretion. Furthermore, elderly men and peri-menopausal women with lower levels of circulating androgens responded better to ART. However, one study involving patients with Sjögren's syndrome showed no improvement in the ART group compared to the placebo control, or to the baseline level. Adverse effects were also common but limited to mild skin problems. In conclusion, androgen is a potential treatment for dry eye disease, especially for people with primary androgen deficiency. Short-term application is relatively safe.

The use of androgen deprivation therapy for prostate cancer and its effect on the subsequent dry eye disease: a population-based cohort study

“…The relationship between ADT and DED has not been established firmly in previous researches [19][20][21]34], while the result of the current study illustrated a minimal influence of ADT on the subsequent DED. About the two studies that showed a significant effect of ADT on DED, one was experimental studies which used DED model to survey the potential relationship between androgen deficiency and DED [19].…”

Histochemical Comparison of Human and Rat Lacrimal Glands: Implications for Bio-Engineering Studies

“…69 It has, for example, been shown that androgen treatment can counteract the effects of dry eye disease in female patients, particularly when peri-menopausal. 70 It would thus be of interest to compare the parameters investigated in the present study between males and females in both the rat and human LG samples in a future study.…”

Autoimmune Epithelitis and Chronic Inflammation in Sjögren’s Syndrome-Related Dry Eye Disease

“…Hormone imbalance, especially androgen deficiency has been reported to be linked to meibomian gland dysfunction [25] and lacrimal gland dysfunction in SS [25,26]. Effectiveness of treatment by androgen is effective for dry eye disease as has been suggested [26][27][28].…”

“…In addition, the lid margin, located at the margin between the conjunctiva and the skin of the eyelid, is frequently damaged in SS-related dry eye disease patients [107]. Androgen deficiency is a pivotal and causative factor in the pathophysiology of dry eye disease and meibomian gland dysfunction that is related to the development of SS-related dry eye disease [27,28]. Compared with common meibomian gland dysfunction patients, SS patients' meibomian glands had higher acinar density, smaller diameters, greater density of periglandular inflammatory cells, and lower secretion reflectivity using in vivo confocal microscopy of meibomian glands in SS [108].…”