Ocular Rhythms: How Hormones Orchestrate Women’s Eye Health

Dhruvi Kalpesh Parekh,

B. Optom Student, KD Institute of Optometry, Ahmedabad, India

 

Hormones are potent chemical messengers that affect both reproductive health and vision. Recent study has shown that sex hormones, particularly oestrogen, progesterone, and androgens, affect women’s ocular structures and functions at various life phases. ^(1–5) Hormonal changes, ranging from adolescence and pregnancy to menopause and contraception use, can contribute to a variety of eye disorders.

Hormonal Receptors in Ocular Tissues

Sex hormone receptors have been in several areas of the eye, including the lacrimal and meibomian glands, cornea, conjunctiva, retina, lens, and choroid. ⁽¹⁾ These receptors allow sex hormones to have a direct impact on tear production, ocular surface integrity, and even retinal and choroidal anatomy. Variations in hormone levels, whether natural or medically induced, can cause ocular impairment.

Dry Eye Disease and Hormonal Fluctuations

Dry Eye Disease (DED) is significantly more common in women, particularly during and after menopause. The decrease in oestrogen and androgens affects all three layers of the tear film: aqueous, lipid, and mucin, affecting ocular surface stability. ^(2,4) Hormonal changes associated with menopause, Poly-Cystic Ovarian Syndrome (PCOS), thyroid disease, and the use of anti-androgen or contraceptive medications have all been related to an increased risk of DED. Understanding these pathways improves diagnosis and treatment, particularly for post-menopausal women.

Oestrogen’s Dual Role

Oestrogen plays a complex role in eye health. It is known to have neuroprotective and vascular benefits, potentially helping in diseases like glaucoma and Leber’s Hereditary Optic Neuropathy, but oestrogen imbalances can also exacerbate ocular surface disorders. ⁽³⁾ For example, some forms of hormone replacement therapy (HRT) or menopause-related oestrogen drop may worsen DED or affect visual function.

Figure 1: Relationship between hormones and women’s eye health ( Created by author )

Oral Contraceptives and the Case for Hormone-Sensitive Eye Care

A study of women taking oral contraceptive pills (OCPs) for more than a year discovered significant thinning in the macula, Retinal Nerve Fibre Layer (RNFL), Ganglion Cell Layer (GCL), and choroidal thickness using OCT scans. ⁽⁵⁾ These findings indicate that hormonal contraceptives can modestly modify retinal and choroidal structures, while the long-term visual implications are unknown. Routine ocular monitoring may be recommended for women on long-term OCP medication.

These findings emphasise the importance of taking hormones into account when providing eye care. The effect of the endocrine system on ocular tissues needs a multidisciplinary approach that includes ophthalmology, endocrinology, and molecular biology. ^(1,4) Identifying hormonal contributions to eye illness enables more targeted therapies. For example, testosterone supplementation or topical insulin are being investigated as potential treatments for hormone-related Dry Eye Disease (DED).

Conclusion

Women’s vision is closely linked to hormonal health. Hormonal changes during life can affect tear production, ocular surface stability, and even retinal structures. Understanding these effects is critical for tailored, proactive eye care for women, which includes encouraging regular exams, particularly during hormonal transitions such as menopause or long-term contraceptive usage. ^(4,5)

 

References

1. Nuzzi R, Caselgrandi P. Sex Hormones and Their Effects on Ocular Disorders and Pathophysiology: Current Aspects and Our Experience. Vol. 23, International Journal of Molecular Sciences. MDPI; 2022.
2. Prakash Maurya R, Gupta A, Verma S, P Singh V, Singh A, Singh V, et al. Sex hormones and dry eye disease: Current update. IP International Journal of Ocular Oncology and Oculoplasty. 2021 Jul 28;7(2):139–50.
3. Hutchinson C V., Walker JA, Davidson C. Oestrogen, ocular function and low-level vision: A review. Vol. 223, Journal of Endocrinology. BioScientifica Ltd.; 2014. p. R9–18.
4. Gorimanipalli B, Khamar P, Sethu S, Shetty R. Hormones and dry eye disease. Vol. 71, Indian Journal of Ophthalmology. Wolters Kluwer Medknow Publications; 2023. p. 1276–84.
5. Shaaban YM, Badran TAF. The effect of oral contraceptive pills on the macula, the retinal nerve fiber layer, the ganglion cell layer and the choroidal thickness. BMC Ophthalmol. 2019 Dec 10;19(1).