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C.G. Connor; Retrospective Analysis of Dry Eye Patients Using 3% Transdermal Testosterone Cream. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3899.
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Purpose:Sullivan’s work has elucidated the connection between male hormone and dry eye. Previously in a masked placebo controlled study we showed that 3% testosterone cream increased tear production in dry eye patients. The present retrospective study analyzes patients treated with testosterone cream to determine which types of dry eye patients are benefited. Methods:Forty consecutive charts of dry eye patients who applied the 3% testosterone cream to their eyelids twice a day for two weeks were analyzed. Mean age of the subjects was 54 yrs. with a range of 23 to 88 yrs , there were 37 females and 3 males. Dry eye was defined by patient symptoms. Baseline TBUT and Schirmer were determined. After two weeks of cream use the same tests were repeated. The data was analyzed by separating the patients into two groups: successful vs. unsuccessful. Successful candidates were defined as those who reported both symptom relief and had an increase in tear production based on an increase in Schirmer test. Results:Based on the criteria described 21 patients were classified as successful. Several more subjects reported a benefit from treatment but showed no objective improvement. Tear breakup time was a poor predictor of success. No significant change in TBUT was observed with either group. Baseline TBUT was 3.3 sec and 3.75 sec in the successful group while the unsuccessful group went from 3.9 sec to 3.4 sec. The successful group was younger 49.6yrs vs. 58.7 than the unsuccessful group. The Schirmer test was predictive for selecting successful patients. In the succesful group it went from a baseline of 7.0 mm to 12.72 mm post treatment while the unsuccessful has a significantly higher baseline Schirmer test 12.64 mm and that decreased to 8.4 mm. There was a 3 times greater prevalence of lid disease among the unsuccessful patients. Conclusions: Patients with reduced tear production received the most benefit from the testosterone cream. While patients with lid disease and normal tear production were poor responders. TBUT was not as useful as the Schirmer test to select potentially responsive patients. The age difference in the two groups suggests that with aging the lacrimal gland may be less responsive to testosterone induced aqueous secretion.
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