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Dry-eye syndrome: an overlooked side effect of HRT

By Megan Rauscher

WESTPORT, CT (Reuters Health) – Women on hormone replacement therapy (HRT), particularly estrogen-only regimens, are at increased risk of keratoconjunctivitis sicca, also known as dry-eye syndrome, researchers report in the November 7th issue of The Journal of the American Medical Association.

"Dry-eye syndrome is a very common condition affecting millions of middle-aged and older women, and physicians should recognize the possibility that HRT may have ocular side effects," Dr. Debra A. Schaumberg, of Brigham and Women's Hospital in Boston, told Reuters Health.

Dr. Schaumberg and colleagues used the Women's Health Study cohort, which included 25,665 postmenopausal women, to study the relationship between HRT and dry-eye syndrome. Participants provided information on the use of HRT at baseline, 12 and 36 months, along with data on dry-eye syndrome at 4 years.

The prevalence of dry-eye syndrome was significantly related to HRT use. Women who used estrogen alone had the highest prevalence at 9.1%, while women who never used HRT had the lowest prevalence at 5.9%. The prevalence of dry-eye syndrome in women who used estrogen plus progesterone/progestin regimens was 6.7%.

In multivariate analyses, the adjusted odds ratio for dry-eye syndrome was 1.69 and 1.29 for estrogen use alone and estrogen plus progesterone/progestin use, respectively, compared with no HRT use.

The risk of dry-eye syndrome appears to increase with longer duration of HRT, according to the data. "Each 3-year increase in the duration of HRT use was associated with a significant 15% elevation in risk of clinically diagnosed dry-eye syndrome or severe symptoms," the investigators report in JAMA.

Dry-eye syndrome is an under-recognized side effect of HRT, Dr. Schaumberg said, "with the caveat that, until our study, there were no epidemiological data available to link the two." Dry-eye syndrome can have "a significant impact on quality of life and can increase risk of ocular infection," the researcher added.

JAMA 2001;286:2114-2119.

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