譯者：聖功醫院婦產科主治醫師 劉奕吟
 

摘要

乾眼症是一種淚水生成的疾患，由許多原因造成，主要的表現為眼睛乾澀合併雙眼搔癢、異物感、灼熱感、或畏光、視力模糊。嚴重的症狀將影響患者視力，降低日常活動及生活品質。Garcia-Alfaro et al. [1] 的觀察性研究蒐集1974位更年期前期及停經後婦女，顯示此族群乾眼症的盛行率較高，且嚴重程度隨著年紀增加而增加。女性進入更年期及停經期後雌激素及雄性素合成減少，導致淚腺及瞼板腺功能障礙，使得淚液生成減少、脂質層分泌不足和角結膜的改變。統合分析及臨床研究 [2,3] 顯示使用「荷爾蒙療法」治療停經後婦女的乾眼症仍有爭議，可能與使用的荷爾蒙劑量及開始使用的時機有關。研究指出荷爾蒙療法可增加淚腺分泌，且效果與年齡相關，因此建議越早治療越好[4]。使用雌激素眼藥水可以顯著改善停經婦女中度至重度的乾眼症症狀[5]，但仍缺乏大型隨機對照試驗佐證。停經後的荷爾蒙療法可以適當地使用，改善乾眼症狀及生活品質。

Summary

The dry eye disease (DED) is a tear production disorder caused by a variety of factors, with dry eyes as the main symptom, and accompanied by binocular itching, foreign body sensation, burning sensation, or photophobia, blurred vision, and other manifestations. Severe symptoms of the DED can mainly affect the patient's visual function, resulting in decreased daily activities and poorer quality of life. Recently, Garcia-Alfaro et al [1] published the results of an observational study which was performed in a group of 1,947 peri- and postmenopausal women. It was found that the prevalence of dry eye symptoms was high in both peri- and postmenopausal women, and the prevalence of dry eye symptoms and Ocular Surface Disease Index (OSDI) scores were higher in postmenopausal women than in perimenopausal ones. The severity of DED symptoms increased with age and decreased with postponement of age at menopause. These findings suggest that menopausal status may be associated with the prevalence and severity of DED symptoms in women. During the menopausal transition and postmenopausal period, hormone levels change, and estrogen and androgen synthesis are reduced, which can cause lacrimal gland and meibomian gland dysfunction, which leads to tear deficiency, tear lipid deficiency, and changes in the kerato-conjunctiva, resulting in the higher prevalence of DED symptoms. Considering that female sex is an important risk factor for eye dryness, the objective data provided by the OSDI questionnaire and ocular examination supports early diagnosis of DED in peri- and postmenopausal women. Menopausal hormone therapy or other related treatments should be given opportunely, thus the DED can be successfully managed, and female quality of life be improved.

References

1. Garcia-Alfaro P, Garcia S, Rodriguez I, Vergés C. Dry eye disease symptoms and quality of life in perimenopausal and postmenopausal women. Climacteric. 2021;24(3):261-266.
   https://pubmed.ncbi.nlm.nih.gov/33283560/
2. Liu C, Liang K, Jiang Z, Tao L. Sex hormone therapy's effect on dry eye syndrome in postmenopausal women: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018t;97(40):e12572.
   https://pubmed.ncbi.nlm.nih.gov/30290618/
3. Schaumberg DA, Buring JE, Sullivan DA, Dana MR. Hormone replacement therapy and dry eye syndrome. JAMA. 2001;286(17):2114-9.
   https://pubmed.ncbi.nlm.nih.gov/11694152/
4. Feng Y, Feng G, Peng S, Li H. The effects of hormone replacement therapy on dry eye syndromes evaluated by Schirmer test depend on patient age. Cont Lens Anterior Eye. 2016;39(2):124-7.
   https://pubmed.ncbi.nlm.nih.gov/26391390/
5. Schmidl D, Szalai L, Kiss OG, Schmetterer L, Garhöfer G. A Phase II, Multicenter, Randomized, Placebo-Controlled, Double-Masked Trial of a Topical Estradiol Ophthalmic Formulation in Postmenopausal Women with Moderate-to-Severe Dry Eye Disease. Adv Ther. 2021;38(4):1975-1986.
   https://pubmed.ncbi.nlm.nih.gov/33710587/