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Sex Hormones and Ocular Dryness
Dry eye syndrome (DES) is strictly connected to systemic and topical sex hormones. Breast cancer treatment, the subsequent hormonal therapy, the subsequent hyperandrogenism and the early sudden menopause, may be responsible for ocular surface system failure and its clinical manifestation as dry eye disease. This local dryness is part of the breast cancer iatrogenic dryness, which affects overall mucosal tissue in the fragile population of those with breast cancer.
Dry eye syndrome is the most common ocular surface disorder, affecting one in five people, with increased prevalence in women than men .
The epidemiological sexual disparity of dry eye prevalence suggests sex hormone changes may influence the composition of the tear film as well as the function of different ocular surface structures and components . Sex hormones, estrogen, progesterone, and testosterone, are known to play important and different roles in ocular surface homeostasis. As such, sex hormones are vital in the production of the main components of our tear film, including the aqueous layer, lipid, and mucin. The absolute hormone levels, their fluctuations, and changes in hormone receptor (HR) responsiveness are all important factors in determining ocular surface stability.
Moreover, in mucosal tissue, the protective mucin barrier appears to be largely influenced by local and circulating sex hormone levels, by modulating key mucin components . This apical epithelial barrier is constituted by transmembrane mucins, carbohydrate-binding proteins named galectins and soluble mucins, which are highly expressed by the ocular surface .
Therefore, the effects of sex hormones are clinically seen in women after breast cancer surgery. In fact, those patients require complex care, since the rapid and necessary treatments lead to a drastic hormonal change, which is abrupt, severe, and unexpected by the patients. The hormonal changes critically subvert the hormonal assets, leading to psychological and physical effects such as a still not well-known systemic dryness. This breast cancer iatrogenic dryness (BCID) may be related: (1) to the functional hyperandrogenism, apparently similar to Polycystic Ovary Syndrome (PCOS), affecting young women; (2) to the pharmacologically induced menopause by aromatase inhibitors (AIs), which causes a two-fold increase in dryness symptoms compared to untreated women; and (3) to a long-term perioperative chemotherapy, which frequently is mandatory .
Recently, some authors focused on the association between dry eye syndrome and breast cancer patients, particularly those using AIs . This could be attributed to the decreased aromatization of the A-cycle of steroids, which leads to the conversion of androgens into estrogens, decreasing the extra-ovarian estrogen production and causing sex hormone imbalance . AIs are also increasingly used for the treatment of postmenopausal patients with estrogen/progesterone receptor-positive breast cancer, in subsequent metastatic settings, and as a tool of chemoprevention in women at increased risk of breast cancer . Hence, a comprehensive assessment of one’s sex hormone dynamics during cancer treatment and appropriate interventional measures may be essential in minimizing ocular and overall mucosal side effects.
This review aims to describe the impact of breast cancer surgery on women’s hormonal setting, by understanding the relationship between physiological sex hormone dynamics and dry eye pathophysiology in similar sex hormone-dependent diseases.
2. The Role of Systemic Hormones Therapy on Ocular Surface
3. Functional Hyperandrogenism on the Ocular Surface
The entry is from 10.3390/jcm10122620
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