Antonella Grasso1, Antonio Di Zazzo2, Giuseppe Giannaccare3, Jaemyoung Sung4, Takenori Inomata4, Kendrick Co Shih5, Alessandra Micera6, Daniele Gaudenzi2, Sara Spelta2, Maria Angela Romeo7, Paolo Orsaria1, Marco Coassin2, Vittorio Altomare1. 1. Breast Unit, University Campus Bio-Medico, 00128 Rome, Italy. 2. Ophthalmology Operative Complex Unit, University Campus Bio-Medico, 00128 Rome, Italy. 3. Department of Ophthalmology, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy. 4. Department of Ophthalmology, School of Medicine, Juntendo University, 1130033 Tokyo, Japan. 5. Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong. 6. Research and Development Laboratory for Biochemical, Molecular and Cellular Applications in Ophthalmological Sciences, IRCCS-Fondazione Bietti, 00198 Rome, Italy. 7. School of Medicine, Humanitas University, 20089 Milan, Italy.
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.
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.
Entities:
Keywords:
breast cancer; dry eye syndrome; ocular surface equilibrium; sex hormones