Hysterectomy, Hormones, and Dry Eyes

Most women know that hysterectomy and ovary removal –castration- leads to a variety of issues – from a dry and painful vagina to hot flashes to mood swings. Heart disease and osteoporosis come to mind as well. However, eye health is not something that is commonly linked to hormones. Since hormone loss and imbalance impacts the eyes, every woman is potentially at risk for dry eyes and even loss of vision.

Dry eye disease can lead to a decreased quality of life, reduced work capacity, and poorer psychological health. Dry eye disease is also associated with a decreased ability to perform activities that require visual attention such as reading and driving a car. I’m all too familiar with the effects of dry eye disease since undergoing an unconsented hysterectomy in 2007. I wrote an article about what happened to me here

I began to have problems with dry eyes within only a few months of the surgery. I made an appointment with my family eye doctor and he told me he saw profound changes in my eyes – especially in my corneas or lenses. He said my eyes had aged a lot since my previous eye exam only a few years prior. They had aged from that of a 40 year old to that of a 60 year old or more. Since I didn’t have diabetes, he said the only reasonable explanation for such rapid changes was hormone loss due to the loss of my ovaries. Eventually, I went on to develop two ulcers on my left cornea. I’m now legally blind in my left eye and can no longer read, work, or drive as I could before.

I had no idea that hysterectomy and castration could lead to dry eyes and loss of vision until it happened to me. In fact, I had no idea how much I needed my tears until I no longer had them.

The eye’s tear film is crucial to eye health and good vision. The tear film is a layer of substances secreted by glands around the eyes and keeps the surface of the eyes lubricated. Tears prevent the cornea from developing erosions, abrasions, and even ulcers which can lead to scarring and vision loss. Tears also provide nutrients for the eyes. And perhaps most important of all, tears reflect or bend light – making vision possible. Poor tear quality can lead not only to eye pain, but impaired vision, and a compromised quality of life.

Most people have seen the Restasis commercial where a woman says her doctor told her she has a disease and then comments that it’s a “big deal”. I agree with her that it’s a big deal to be diagnosed with dry eye disease. Restasis was the first prescription dry eye drug to be FDA approved and remains the only prescription drop on the market that is meant to help a person to make more of their own tears. I have to say though that it’s an expensive eye drop ($200 plus) and it takes several months to really begin to work –  if even then. Many patients taking Restasis continue to need supplementation with artificial tears too. So, not making your tears is not something that is easily remedied.

As many as 70% of those diagnosed with dry eye disease may actually
have Meibomian Gland Disease or “MGD”. I’ve actually been diagnosed with MGD myself. MGD occurs when the oil glands in the eyelids, responsible for producing oil, become clogged and/or dry up. This is a serious condition that causes loss of vital eye protection. Meibomian glands are the oil-producing glands located in both the upper and lower eyelids and they slowly release oil into the tear film. This oil helps to stop the water in the tears from evaporating and prevents dry eyes.

When my cornea specialist tested the quality of my tears by using Schirmer’s test (paper strips inserted into the eye), he found them to be the consistency of toothpaste. That’s obviously not good, so he prescribed an eyelid wash for me to use twice a day and he also recommended I purchase a special cloth which is heated and placed over the eyes to help moisten the glands in the eyelashes. Treating dry eye disease and MGD is very time-consuming to say the least.

Knowing about the link between hormones and dry eye disease is especially important for any woman who is interested in undergoing LASIK surgery since this can permanently affect nerve function of the eye’s clear surface or cornea and worsen dry eye problems. Before undergoing LASIK surgery, any woman who has undergone hysterectomy and castration should be sure to tell her eye doctor about any dry eye condition so special tests can be performed  to determine if the eyes are moist enough for laser vision correction or not.

It should be noted that many medications may cause or worsen dry eye problems too. Diuretics, antidepressants and bladder control medications are all commonly prescribed for women, and yet, they very much contribute to dry eyes. So, any dry eye condition should be discussed with all doctors prescribing these and any other medications.

Dry eye disease is a painful and life-changing situation to be sure, but there are steps a woman can take to help increase tears. Improving the Omega-3-lipid component of the tears leads to better lubrication since the eye surface has an oily film to begin with. A study published in the American Journal of Clinical Nutrition analyzed data from an ongoing women’s health study which indicated that women who ate a daily intake of Omega-3s EPA and DHA in a natural triglyceride form reduced the risk of dry eye disease by up to 66%. I’ve been taking Omega-3s EPA and DHA for years and I think it most definitely has helped.

There’s also been a good amount of research done by Dr. David A. Sullivan that points to success with testosterone supplementation in helping to relieve dry eye disease.  Dr. Sullivan is a Ph.D. graduate of Dartmouth Medical school, an Associate Professor in the Department of Ophthalmology at Harvard Medical School and a Senior Scientist at the Schepens Eye Research Institute. During the past 32 years, his research has focused upon the interrelationships between sex, sex steroids and dry eye disease and has led to authorship on over 200 scientific articles and 10 patents, as well as to the development of potential therapies for aqueous-deficient and evaporative dry eye disease.

Dr. Sullivan’s research indicates that a testosterone deficiency causes meibomian gland dysfunction, tear instability, and evaporation of tears. Therefore, he suggests that eye drops containing testosterone may be a safe and effective way to treat dry eye disease. I haven’t tried testosterone eye drops yet, but I’m very interested. My cornea specialist has routinely prescribed topical azithromycin which is the most commonly prescribed MGD treatment in the U.S. Its use is off-label though since it has not been specifically approved by the FDA for patients with MGD. This particular antibiotic is thought to be effective because of its anti-inflammatory and anti-bacterial actions, which may suppress the MGD-associated inflammation and growth of lid bacteria.

Study findings at Schepens Eye Research may help lead to broader use of topical azithromycin as an FDA-approved on-label treatment of MGD and its associated evaporative dry eye disease.

Please visit my website for more information regarding the link between hormones and eye health here.

This post was published previously in October 2014.