Testosterone Replacement Therapy and Dry Eye
Yes, testosterone replacement therapy (TRT) can potentially cause dry eye due to hormonal changes that affect the ocular surface and tear film stability.
Pathophysiological Mechanism
- Dry eye can develop as a result of a decrease in supportive factors such as androgen hormones, which play a role in maintaining the ocular surface and tear-secreting glands that function as an integrated unit 1
- The ocular surface microenvironment requires hormonal balance to maintain homeostasis, and disruption of this balance through exogenous hormone administration can lead to dry eye symptoms 1
- Androgens impact the structure and function of the meibomian and lacrimal glands, which are essential for tear production and quality 2
Risk Factors for Dry Eye Related to Hormones
- Hormone replacement therapy, particularly estrogen use alone, has been associated with an increased risk of dry eye syndrome in postmenopausal women 1, 3
- While most research focuses on estrogen's effects, testosterone levels also influence ocular surface health 4, 2
- Hormonal fluctuations can disrupt the tear film stability and contribute to dry eye symptoms 1
Clinical Presentation of TRT-Related Dry Eye
- Patients may experience symptoms including:
- Ocular irritation (burning, gritty, or sandy sensation)
- Redness
- Mucus discharge
- Fluctuating vision 1
- Signs may include decreased tear meniscus or meibomian gland dysfunction 1
- Symptoms may worsen with environmental factors such as reduced humidity, increased wind, air conditioning, or heating 1
Management Considerations
- Identify and modify environmental factors that may exacerbate symptoms 5
- Consider preservative-free ocular lubricants, especially if using more than four times daily 5
- Implement eyelid hygiene and warm compresses to improve meibomian gland function if meibomian gland dysfunction is present 5
- For persistent symptoms, consider tear conservation strategies such as punctal occlusion 5
Important Considerations and Pitfalls
- Dry eye symptoms may fluctuate with testosterone administration, particularly with injectable forms that create hormonal peaks and troughs 6
- Consider alternative TRT delivery methods (e.g., topical gels) that provide more stable hormone levels if ocular symptoms correlate with injection timing 6
- Do not overlook the importance of treating underlying blepharitis or meibomitis which can contribute to symptoms 5
- Recognize that tear replacement alone may be unsuccessful if the hormonal cause is not addressed 5
Monitoring and Follow-up
- Regular assessment of ocular symptoms during TRT is advisable, especially in patients with pre-existing dry eye or risk factors 1
- For severe or persistent symptoms, referral to an ophthalmologist is recommended 5
- Consider evaluating both tear production and meibomian gland function, as TRT may affect both aqueous and lipid components of the tear film 1