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February 6, 2002

Dry Eye Syndrome in Postmenopausal Women

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(5):585-586. doi:10.1001/jama.287.5.583

To the Editor: Dr Schaumberg and colleagues1 concluded that women who receive hormone replacement therapy (HRT), especially with unopposed estrogen therapy, have an increased risk of dry eye syndrome. Although they found no medical conditions to have a confounding impact, they did not consider rosacea in the list of confounding conditions.

Clinically significant rosacea occurs in approximately 30% of menopausal women.2 The diagnosis of rosacea is based on the finding of persistent erythema, prominent telangiectases, and papulopustules of the cheeks, chin, and forehead. Easy flushing or blushing due to physical exertion or consumption of hot beverages is also characteristic. Noticeably lacking are the comedones that characterize acne vulgaris. The authors' failure to include rosacea as a confounding condition is significant because of the coexistence of this cutaneous condition with ocular rosacea. Ocular rosacea is a common cause of dry eye or keratoconjunctivitis sicca.3 While the incidence of ocular rosacea is not known, it may be present in as many as 58% of patients with rosacea and has been suggested to be present in up to 75% of perimenopausal women with facial rosacea.2,4 Another study found all patients with cutaneous rosacea to have some degree of ocular involvement.5 Common symptoms of ocular rosacea include irritation and dryness, the same 2 symptoms assessed by Schaumberg et al.