Testosterone for Dry Eye
for Dry Eye Syndrome by Jeffrey Dach MD
Mrs. B was 58 years old with typical menopausal symptoms of night sweats and hot flashes, and came to see me because of dry itchy, red eyes. The lids sometimes swell because of the irritation. 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 has been given instructions for cleaning and irrigating the eyes. The eye drops seem to help somewhat but the irritation always returns whenever she stops them. Lately, the condition is getting worse and nothing seems to help.
Above left image: courtesy of wikimedia commons, red arrow points to meibomian glands in edge of eye lid which secrete oil which lubricates the eye.
Low Testosterone Level
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.
Cured With Testosterone, Surely You Must Be Joking, Doctor
Six week later, after starting her testosterone as sublingual drops, Mrs B reported her eyes were much better. She also started a complete bioidentical 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 (no name) 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 were quite distinctive.
Testosterone for Dry Eyes
in the Opthalmology Medical Literature
Apparently, Dr H is unaware of the supportive evidence in his own specialty medical journals. We will look at a few of these supportive articles that recommend testosterone for evaporative dry eye syndrome. About 5 million Americans have Dry Eye Syndrome caused by dysfunction of the lubricating glands, which are called the lacrimal and meibomian glands. The small glands at the upper outer eye are the lacrimal glands, and the meibomian glands are located in the eye lid at the upper and lower edges (see diagram below).
Left Image :Tear system: a. tear gland / lacrimal gland, b. superior lacrimal punctum, c. superior lacrimal canal, d. tear sac / lacrimal sac, e. inferior lacrimal punctum, f. inferior lacrimal canal, g. nasolacrimal canal.
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.(4)
Dr Sullivan Research in Mouse Model Of Sjogren’s
Dr. Sullivan’s early work in the 1990’s involved Sjogrens syndrome, and the discovery that women with Sjögren’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. (1) 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.(6)
Lacrimal and Meibomian Glands Regulated by Testosterone
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 Sjögren’s syndrome.(1)
Left Image: Chalazion, obstructed, infected meibomian gland upper eye lid. This image is useful to give you an idea of where the glands are locared in the lid. There are 20 – 30 small Meibomian glands located along the edge of the upper and lower lid that secrete oil which lubricates the surface of the eye. When one becomes obstructed, it swells up and is called a Chalazion. Treatment is to relieve the obstruction and allow drainage. Courtesy of wikimedia commons.
Men on Testosterone Blockers Get Dry Eyes
In 2000, Dr Sullivan reported that men taking testosterone blockers have dry eye syndrome. Men on testosterone blocker drug treatment for prostate cancer were found to had poor quality of tear fluid. 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.” (2)
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, medical terms for Dry Eyes. (3)
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 (5).
Trans-Dermal Testostorone For Dry Eye Syndrome
In 2003, DrConnor reported transdermal testosterone is safe and effective treatment for dry eye, with the post-menopausal females having the greatest relief of symptoms. (10)
Molecular Biology Mouse Studies of Gene Expression
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.
The Evidence is Overwhelming
The sum total of the above evidence is overwhelming that testosterone playes a key role in production of oil, the lipid component for lubricating the eyes, and that testosterone deficiency is a treatable cause of dry eye syndrome. The treatment is testosterone, a bioidentical hormone.