Attaining Healthy Sight can present some challenges that are unique to women. Many of these relate to the increased tendency toward ocular surface irritation in females that contribute to eyestrain and fatigue and detract from Healthy Sight. Of particular importance are dry eye states, which are far more common in women than in men. Hormonal fluctuations occurring in women in association with menses, pregnancy, and menopause can produce refractive shifts and lead to tear film instability. The long-term use of eye make-up (especially mascara) can produce a chronic conjunctivitis on a toxic, irritative, or allergic basis and contribute to the development of dry eye states, as can cosmetic eyelid surgery where tightening of the lids decreases the frequency and amplitude of the blink and impairs surface lubrication. Females are also more likely to wear contact lenses than males, making them more susceptible to lens-related irritation.
Hormonal Changes and Dry Eye
Hormone changes figure in the homeostasis and function of the ocular surface. There are both estrogenic and androgenic receptors located on corneal and conjunctival epithelia and the Meibomian glands. Natural hormonal changes associated with the menstrual cycle, pregnancy, and menopause can affect tear production and surface lubrication.
Dry eye is generally more common in women than in men, and more common in those over age 40 than in younger individuals. In post-menopausal women, endocrine changes and other physiologic changes associated with aging figure in the pathogenesis of dry eye. There is some controversy over whether estrogen deficiency, androgen deficiency, or the imbalance of the two hormone groups impair ocular surface function. Therapy for dry eye generally involves the topical administration of tear substitutes. Hormone replacement therapy may have an ameliorative effect on dry eye. Estrogen or androgen-based eye drops are a potentially promising treatment. When tear replacement is not enough to alleviate symptoms and signs of dry eye, punctal occlusion can prove helpful in making better use of naturally produced tears. Recently, an inflammatory component of dry eye states has been recognized, leading to the successful use of topical cyclosporine in treating severe or recalcitrant dry eyes.
Disorders characterized by sex hormone deficiencies have been associated with dry eye. A relatively common example is premature ovarian failure (with a prevalence of 1% in women under age 40), which has various causes, including chemotherapy, radiation therapy, immune dysfunction, and genetic predisposition. Women who experience premature ovarian failure are at increased risk for dry eye.