Dry eye syndrome as a result of androgen deficiency in the aging male, "Beyond the Abstract," by Anat Galor, MD, MSPH

BERKELEY, CA (UroToday.com) - Dry eye (DE) is a group of eye diseases that causes ocular discomfort and can significantly decrease quality of life. Normally, a tear film composed of three layers protects the eye. From outermost to innermost, the layers are lipid, aqueous, and mucous. The lipid and aqueous layers are primarily maintained by the meibomian and lacrimal glands, respectively. A disruption in any one of these layers can lead to DE.

About 7 million Americans suffer from DE, with an estimated $55 billion spent in the U.S. each year treating the symptoms of the disease, not curing it. One potential avenue for a cure involves androgens. Androgens are hormones produced by the adrenal glands (DHEA, DHEAS, androstenedione), gonads (testosterone), and peripheral tissues (DHT). Various androgen-depleted states have shown meibomian gland dysfunction and abnormal tear film parameters, including patients on anti-androgen medications (for prostate cancer or benign prostatic hyperplasia), those with chronic androgen insensitivity syndrome and, Sjögren syndrome.

Another androgen deficient state is andropause. Andropause occurs in males aged 40 or older and refers to the symptoms associated with a decrease in androgen levels. Unfortunately, there is little information on the relationship between this decrease in androgens and DE. Our study evaluated the relationship between androgens and subjective and objective measures of DE in an aging male population. Our study showed there was a weak positive correlation between healthier tear film parameters and higher levels of androstenedione, thus supporting a relationship between androgen deficiency and DE and the potential use of androgen treatment to help DE patients.

Interestingly, limited data are available on androgen administration in DE. One study, for example, found that females with lipid tear deficiency (a sub-type of DE) improved after transdermal androgen patch therapy. In the news, Dr. Allan Panzer is making headlines for treating his DE patients with topical androgens, with much reported success. While not every DE patient may benefit from androgen therapy, these studies, and ours, indicate that more investigation is warranted to study the role and potential benefits of androgens in DE.

Written by:
Anat Galor, MD, MSPH as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Staff Physician, Miami Veterans Affairs Medical Center
Associate Professor of Clinical Ophthalmology
Bascom Palmer Eye Institute
University of Miami Miller School of Medicine

Androgen deficiency and dry eye syndrome in the aging male - Abstract

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