Dry Eye Signs and Symptoms in Women With Premature Ovarian Failure | External Eye Disease | JAMA Ophthalmology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Coulam  CBAdamson  SCAnnegers  JF Incidence of premature ovarian failure.  Obstet Gynecol. 1986;67604- 606PubMedGoogle Scholar
Anasti  JNKalantarisou  SNKimzey  LMDefensor  RANelson  LM Bone loss in young women with karyotypically normal spontatneous prematureovarian failure.  Obstet Gynecol. 1998;9112- 15PubMedGoogle ScholarCrossref
Bakalov  VKVanderhoof  VHBondy  CANelson  LM Adrenal antibodies detect asymptomatic auto-immune adrenal insufficiencyin young women with spontaneous premature ovarian failure.  Hum Reprod. 2002;172096- 2100PubMedGoogle ScholarCrossref
Miyake  TSato  YTajeuchi  S Implications of circulating autoantibodies and peripheral blood lymphocytesubsets for the genesis of premature ovarian failure.  J Reprod Immunol. 1987;12163- 171PubMedGoogle ScholarCrossref
Hoek  Avan Kasteren  YDe Haan-Meulman  MHooljkass  HSchoemaker  JDreshage  H Analysis of peripheral blood lymphocyte subsets, NK cells and delayedtype hypersensitivity skin test in patients with premature ovarian failure.  Am J Reprod Immunol. 1995;33495- 502PubMedGoogle ScholarCrossref
Schein  ODMunoz  BTielsch  JMBandeen-Roche  KWest  S Prevalence of dry eye among the elderly.  Am J Ophthalmol. 1997;124723- 728PubMedGoogle Scholar
Lemp  MA Report of National Eye Institute/Industry workshop on clinical trialsin dry eyes.  CLAO J. 1995;21221- 232PubMedGoogle Scholar
Bron  AJ Diagnosis of dry eye.  Surv Ophthalmol. 2001;45suppl 2S221- S226PubMedGoogle ScholarCrossref
Mathers  WDStovall  DLane  JAZimmerman  MBJohnson  S Menopause and tear function: the influence of prolactin and sex hormoneson human tear production.  Cornea. 1998;17353- 358PubMedGoogle ScholarCrossref
Sullivan  DAKrenzer  KLSullivan  BDTolls  DBToda  IDana  MR Does androgen insufficiency cause lacrimal gland inflammation and aqueoustear deficiency?  Invest Ophthalmol Vis Sci. 1999;401261- 1265PubMedGoogle Scholar
McClellan  KARobertson  FGKindblom  J  et al.  Investigation of the role of prolactin in the development and functionof the lacrimal and harderian glands using genetically modified mice.  Invest Ophthalmol Vis Sci. 2001;4223- 30PubMedGoogle Scholar
Krenzer  KLDana  MRUllman  MD  et al.  Effect of androgen deficiency on the human meibomian gland and ocularsurface.  J Clin Endocrinol Metab. 2000;854874- 4882PubMedGoogle Scholar
Schaumberg  DABuring  JESullivan  DADana  MR Hormone replacement therapy and dry eye syndrome.  JAMA. 2001;2862114- 2119PubMedGoogle ScholarCrossref
Sullivan  BDEvans  JECermak  JMKrenzer  KLDana  MRSullivan  DA Complete androgen insensitivity syndrome: effect on human meibomiangland secretions.  Arch Ophthalmol. 2002;1201689- 1699PubMedGoogle ScholarCrossref
Sullivan  BDEvans  JEKrenzer  KL  et al.  Impact of anti-androgen treatment on the fatty acid profile of neutrallipids in human meibomian gland secretions.  J Clin Endocr Metab. 2000;854866- 4873PubMedGoogle Scholar
Sullivan  DASullivan  BDEvans  JE  et al.  Androgen deficiency, meibomian gland dysfunction and evaporative dryeye.  Ann N Y Acad Sci. 2002;966211- 222PubMedGoogle ScholarCrossref
van Bijsterveld  OP Diagnostic tests in the sicca syndrome.  Arch Ophthalmol. 1969;8210- 14PubMedGoogle ScholarCrossref
Bron  AJ The Doyne Lecture: reflections on the tears.  Eye. 1997;11583- 602PubMedGoogle ScholarCrossref
Pflugfelder  SCTseng  SCSanabria  O  et al.  Evaluation of subjective assessments and objective diagnostic testsfor diagnosing tear-film disorders known to cause ocular irritation.  Cornea. 1998;1738- 56PubMedGoogle ScholarCrossref
Vitali  CMoutsopoulos  HMBombardieri  S The European Community Study Group on diagnostic criteria for Sjögren'ssyndrome: sensitivity and specificity of tests for ocular and oral involvementin Sjögren's syndrome.  Ann Rheum Dis. 1994;53637- 647PubMedGoogle ScholarCrossref
Schiffman  RMChristianson  MDJacobsen  GHirsch  JDReis  BL Reliability and validity of the Ocular Surface Disease Index.  Arch Ophthalmol. 2000;118615- 621PubMedGoogle ScholarCrossref
Mangione  CMLee  PPPitts  J  et al.  Psychometric properties of the National Eye Institute Visual FunctionQuestionnaire (NEI-VFQ).  Arch Ophthalmol. 1998;1161496- 1504PubMedGoogle ScholarCrossref
Mangione  CMLee  PPGutierrez  PRSpritzer  KBerry  SHays  RD Development of the 25-item National Eye Institute Visual Function Questionnaire.  Arch Ophthalmol. 2001;1191050- 1058PubMedGoogle ScholarCrossref
The National Eye Institute 25-Item Visual Function Questionnaire–version2000, Available at: http://www.rand.org/health/surveys/vfq25/scoring.pdf. Access verified September 9, 2003.
Vitali  CBombardieri  SJonsson  R  et al.  Classification criteria for Sjögren's syndrome: a revised versionof the European criteria proposed by the American-European Consensus Group.  Ann Rheum Dis. 2002;61554- 558PubMedGoogle ScholarCrossref
Smith  RETaylor  CRRao  NA  et al.  Immunohistochemical identification of androgen receptors on the humanlacrimal glands.  Curr Eye Res. 1999;18300- 309PubMedGoogle ScholarCrossref
Fuchsjager-Mayrl  GNepp  JSchneeberger  C  et al.  Identification of estrogen and progesterone receptor mRNA expressionin the conjunctiva of premenopausal women.  Invest Ophthalmol Vis Sci. 2002;432841- 2844PubMedGoogle Scholar
Tachibana  MKobayashi  YKasukabe  T  et al.  Expression of androgen receptor in mouse eye tissues.  Invest Ophthalmol Vis Sci. 2000;4164- 66PubMedGoogle Scholar
Wickham  LABao  JToda  I  et al.  Identification of androgen, estrogen and progesterone receptor mRNA'sin the eye.  Acta Ophthalmol Scand. 2000;78146- 153PubMedGoogle ScholarCrossref
Esmaeli  BHarbey  JTHewlett  B Immunohistochemical evidence for estrogen receptors in meibomian glands.  Ophthalmology. 2000;107180- 184PubMedGoogle ScholarCrossref
Suzuki  TKinoshita  YTachibana  M  et al.  Expression of sex steroid hormone receptors in human cornea.  Curr Eye Res. 2001;2228- 33PubMedGoogle ScholarCrossref
Rocha  EMWickham  LAda Silveira  LA  et al.  Identification of androgen receptor protein and 5 alpha-reductase mRNAin human ocular tissues.  Br J Ophthalmol. 2000;8476- 84PubMedGoogle ScholarCrossref
Marin-Castano  MElliot  SPotier  M  et al.  Regulation of estrogen receptor and MMP-2 expression by estrogens inhuman retinal pigment epithelium.  Invest Ophthalmol Vis Sci. 2003;4450- 59PubMedGoogle ScholarCrossref
Cutolo  MBijlsma  JWLahita  R  et al.  Preface: altered neuroendocrine immune (NEI) networks in rheumatology.  Ann N Y Acad Sci. 2002;966xiii- xviiiGoogle ScholarCrossref
Sullivan  DSullivan  BEvans  JSchirra  F  et al.  Androgen deficiency, meibomian gland dysfunction and evaporative dryeye.  Ann N Y Acad Sci. 2002;966211- 222PubMedGoogle ScholarCrossref
Hykin  PGBron  AJ Age-related morphological changes in lid margin and meibomian glandanatomy.  Cornea. 1992;11334- 342PubMedGoogle ScholarCrossref
Melner  MHFeltus  FA Autoimmune premature ovarian failure-endocrine aspects of a T celldisease [editorial].  Endocrinology. 1999;1403401- 3403PubMedGoogle Scholar
Lahita  RG Predisposing factors to autoimmune disease.  Int J Fertil Womens Med. 1998;43229- 234PubMedGoogle Scholar
Perheentupa  J APS-1 / APECED: the clinical disease and therapy.  Endocrinol Metab Clin North Am. 2002;31295- 320PubMedGoogle ScholarCrossref
De Baere  DDixon  MJSmall  KW  et al.  Spectrum of FOXL2 gene mutations in blepharophimosis-ptosis-epicanthus-inversusfamilies demonstrates a genotype-phenotype correlation.  Hum Mol Genet. 2001;101591- 1600PubMedGoogle ScholarCrossref
Al-Abdulmunem  M Relation between tear breakup time and spontaneous blink rate.  Int Contact Lens Clin. 1999;26117- 120PubMedGoogle ScholarCrossref
Gupta  AHeigle  TPflugfelder  SC Nasolacrimal stimulation of aqueous tear production.  Cornea. 1997;16645- 648PubMedGoogle ScholarCrossref
Maudgil  SSKhurana  AKSingh  MParmar  IPAhluwalia  BK Tear film flow and stability in normal Indian subjects.  Indian J Ophthalmol. 1989;37182- 183PubMedGoogle Scholar
Feldman  FWood  MM Evaluation of the Schirmer tear test.  Can J Ophthalmol. 1979;14257- 259PubMedGoogle Scholar
Nichols  KKMitchell  GLZadnik  K Performance and repeatability of the NEI-VFQ-25 in patients with dryeye.  Cornea. 2002;21578- 583PubMedGoogle ScholarCrossref
Mangione  CMLee  PPPitts  J  et al.  Psychometric properties of the NEI-VFQ Field Test Investigators.  Arch Ophthalmol. 1998;1161496- 1504PubMedGoogle ScholarCrossref
Scott  IUSmiddy  WESchiffman  J  et al.  Quality of life of low-vision patients and the impact of low-visionservices.  Am J Ophthalmol. 1999;12854- 62PubMedGoogle ScholarCrossref
Clinical Sciences
February 2004

Dry Eye Signs and Symptoms in Women With Premature Ovarian Failure

Author Affiliations

From the Division of Epidemiology and Clinical Research, National EyeInstitute (Drs Smith, Vitale, and Reed), Clinical Center (Mss Grieshaber andGoodman), Developmental Endocrinology Branch, National Institute of ChildHealth and Human Development, National Institutes of Health (Ms Vanderhoofand Drs Calis and Nelson), Bethesda, Md. The authors have no relevant financialinterest in this article.

Arch Ophthalmol. 2004;122(2):151-156. doi:10.1001/archopht.122.2.151

Objective  To examine whether women with premature ovarian failure (POF) have abnormalfindings in ocular surface or tear parameters and whether they report symptomsof ocular discomfort compared with age-matched controls.

Methods  Sixty-five patients with POF and 36 age-matched healthy controls wereexamined for signs and symptoms of dry eye. The Ocular Surface Disease Indexquestionnaire and the 25-item National Eye Institute Visual Function Questionnaire(NEI-VFQ 25) were administered to the participants. Assessments of ocularsurface damage (Oxford and van Bijsterveld scores of vital dye staining) andtear status (Schirmer tests 1 [without anesthesia] and 2 [with anesthesia]and tear breakup time) were performed.

Results  Women with POF scored significantly worse than controls on all ocularsurface damage parameters: Oxford score (3.2 vs 1.7; P =.001), conjunctival lissamine green (2.1 vs 1.3; P =.02), corneal fluorescein staining (1.2 vs 0.4; P =.005), and van Bijsterveld score (2.1 vs 1.3; P =.02). Further, the proportion of patients with POF meeting the dry eye diagnosticcriterion of a van Bijsterveld score greater than or equal to 4 was significantlygreater among women with POF than among controls (20% vs 3%; P = .02). The POF group also tended to have worse scores than controlson self-reported symptoms, as measured by the overall Ocular Surface DiseaseIndex (12.5 vs 2.1; P<.001) and the overall NEI-VFQ(94 vs 98; P = .001) afteradjustment for age and race. Schirmer test scores and tear breakup time didnot differ.

Conclusions  Women with POF were more likely to exhibit ocular surface damage andsymptoms of dry eye than age-matched controls. They were not, however, morelikely to have reduced tear production. To our knowledge, this associationbetween ocular surface disease and POF has not been previously reported. Thesedata provide further evidence of the multifaceted role of sex hormones inthe health and disease of the ocular surface.