About 5 million Americans have Dry Eye Syndrome caused by dysfunction of the small lubricating glands, which are called the lacrimal (upper outer eye) and meibomian (in the eye lid at the upper and lower edges) glands.
Mrs. B was 58 years came to see me because of her dry itchy, red eyes.
Her lids would sometimes swell because of the irritation. She had the typical menopausal symptoms of night sweats and hot flashes as well.
Over the years, Mrs. B. had been to numerous eye doctors who gave her various drops to lubricate the eye, antibiotic drops and steroid drops.
She had been given instructions for cleaning and irrigating the eyes. The eye drops seemed to help somewhat, but the irritation always returned whenever she stopped them.
Lately, the condition was getting worse and nothing seemed to help.
Low testosterone linked to Dry Eye Syndrome
A routine hormone panel showed that Mrs B had low hormone levels, and her testosterone level was especially low.
I explained to Mrs B that her dry eye syndrome was caused by low testosterone levels, and testosterone would help.
Six week later, after starting her testosterone as sub lingual drops, Mrs B reported her eyes were much better. She also started a complete bio-identical hormone program.
Mrs. B’s ophthalmologist, Dr. H, was an old friend of mine and we would occasionally attend the same social functions. At one of these social functions, Dr. H approached to say that a patient of his (no name given, of course) reported that I had cured her dry eyes with testosterone, and surely you must be joking, Doctor.
His gesture and facial expression with his eyes rolling back made it quite clear what he thought of my diagnosis and treatment.
Apparently, Dr. H was unaware of the supportive evidence for my diagnosis in his own specialty medical journals. Luckily for Mrs B. I wasn’t.
Let’s take a look at a few of these studies linking testosterone to evaporative dry eye syndrome.
Dr. David A. Sullivan and Dry Eye Research
Much of the research on testosterone and dry eyes has been done by David A. Sullivan, at Schepens Eye Research Institute at Harvard Medical School.
Dr. Sullivan’s early work in the 1990’s involved Sjogren’s syndrome.
It had been discovered that women with Sjogren’s syndrome are androgen-deficient causing meibomian gland dysfunction, tear film instability, and the evaporative dry eye characteristic Sjogren’s, which is an autoimmune disorder.
Sullivan published a study in 1991 which showed that testosterone inhibited the progression of autoimmune disease in the lacrimal glands mice with Sjogren’s. His mouse model of Sjogren’s showed that the testosterone suppressed the magnitude of lymphocyte infiltration in the lacrimal gland 22- to 46-fold.
In a 1999 report, Sullivan suggested that androgens (testosterone) regulate both lacrimal and meibomian gland function, and suggest that eye drops containing testosterone may be safe and effective treatment for dry eyes in Sjogren’s syndrome.
Men on testosterone blockers get dry eyes
In 2000, Dr. Sullivan reported that men taking testosterone blockers often have dry eye syndrome.
In addition men on testosterone blocker drug treatments for prostate cancer were found to have poor tear fluid quality. This was demonstrated by analyzing the meibomian gland secretions. Their dry eye symptoms included light sensitivity, painful and blurry eyes.
Sullivan said,”the use of anti-androgen pharmaceuticals was associated with significant changes in the relative amounts of lipids in meibomian gland secretions. Our findings indicate that chronic androgen deficiency is associated with meibomian gland dysfunction and dry eye.”
In 2001, Drs. Worda and Nepp from Vienna Austria reported that topically administered androgen can restore the lipid phase of the tear film, and was useful in treatment of keratoconjunctivitis sicca, the medical terms for Dry Eyes.
Complete insensitivity to androgen and dry eyes
Next, Dr. Sullivan turned his attention to a genetic disorder called Complete Insensitivity to Androgen (CIAS). In this genetic disorder, the androgen receptor is nonfunctional, and subsequently, there is insensitivity to testosterone. Without a functioning receptor, the normal activity of testosterone is completely blocked.
Dr. Sullivan examined the tears (ie. Meibomian gland secretions), in women with CIAS and compared them to normal controls.
The patients with CIAS had alteration in the lipid fractions of tear fluid, ( ie meibomian gland secretions). This study was published in a 2002 report in Arch Ophthalmology.
In 2003, Dr. Connor reported transdermal testosterone is safe and effective treatment for dry eye, with post-menopausal females having the greatest relief of symptoms.
In 2005, Dr Schirra et al studied the molecular biology of testosterone, and gene expression in the meibomian gland of mice. Dr Schirra reported that testosterone regulates the expression of more than 1500 genes in the mouse meibomian gland which serves to stimulate lipid and fatty acid metabolism in the lubricating eye fluid.
Evidence of the testosterone dry eye link is overwhelming
The sum total of the above evidence is overwhelming that testosterone plays a key role in production of oil, the lipid component for lubricating the eyes.
It’s clear that testosterone deficiency is a treatable cause of dry eye syndrome. The treatment is testosterone, a bioidentical hormone.
Jeffrey Dach MD is founder of TrueMedMD, a clinic in Hollywood, Florida specializing in Bioidentical Hormones and Natural Thyroid. Originally Board Certified in Diagnostic and Interventional Radiology, Dr. Dach is also Board Certified by the American Academy of Anti-Aging Medicine.
Dr Dach is author of the book, Natural Medicine 101, available on Amazon or as a free e-book at www.naturalmedicine101.com.
His office is located at 4700 Sheridan Suite T, Hollywood Florida 33021. Telephone 954-983-1443.
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