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Ilaria Macchi, Laura Guccione, Flavio Mantelli, Alessandra Micera, Costanzo Moretti, Stefano Bonini; Ocular surface findings associated to clinical signs of hyperandrogenism assessed by an innovative videodermoscopic method. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5428. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate whether ocular surface parameters in patients with Polycystic Ovary Syndrome (PCOS), the most common endocrine disorder in women of reproductive age, correlate with the severity of hirsutism, the main sign of hyperandrogenism. In fact, cornea, conjunctiva, meibomian and lacrimal glands express sex hormone receptors as well as the skin, and represent, therefore, potential androgen targets.
Four PCOS patients were evaluated by videodermoscopy and ophtalmic examination at baseline (T0) and after 12 months (T12) of treatment with systemic anti-androgen therapy (Bicalutamide 50mg/die). Four healthy age-matched females were used as controls. The ophtalmic evaluation included slit lamp examination, lacrimal function tests (BUT, Schirmer I), and conjunctival impression cytology for the analysis of goblet cell by PAS and immuno-staining. The skin evaluation consisted in the collection of photos and calculation of the videodermoscopic index (VI) at 2 representative androgen-dependent areas of hair growth (chin and linea alba) using a new videodermoscopic software (Alfadoc, Medical Hi-Tek). Ocular surface data were correlated statistically to the VI.
All women included in this study had PCOS with clinically relevant hirsutism. PCOS patients had a reduction of BUT (4.9±2.2sec vs. 9.1±1.3sec in the controls, p<0.05) accompanied by an increase in goblet cell number (70±34/mm2 vs. 30±16/mm2 in the controls, p<0.05), and a degree of hirsutism that was significantly reduced (p<0.05) by systemic anti-androgen therapy (chin T0 VI=3.5±0.5; T12 VI=1±1; linea alba T0 V.I.=3±1; T12 V.I.=1±1). Systemic anti-androgen treatment also resulted in an improvement of tear film break-up time (6.7±1.2sec), and a reduction in goblet cell number (26±15/mm2).
Previous reports suggested that the ocular surface is affected by the modified sex hormones levels in PCOS, with tear film instability, increased goblet cell number and mucous discharge. In this study we show that ocular surface findings are improved by systemic anti-androgen treatment in PCOS and correlate with the severity of the androgen excess-related skin signs. Our data supports the hypothesis that ocular surface and lacrimal function are influenced by hyperandrogenemia, suggesting that they could represent new useful parameters to evaluate the effects of systemic anti-androgen treatment in PCOS.
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