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JA Smith, GF Reed, S Grieshaber, L Goodman, VH Vanderhoof, LN Nelson; Dry Eye in Patients with Karyotypically Normal Spontaneous Premature Ovarian Failure . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3890.
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Purpose:Premature ovarian failure (POF) is characterized by amenorrhea, hypoandrogenemia, hypoestrogenemia, and elevated gonadotropins in women younger than 40 years of age. Dry eye can occur at any age, and in any race or gender, but is commonly found in peri- and post-menopausal women, who also have decreased circulating androgens and estrogens. The purpose of this study is to determine the prevalence of dry eye in women with premature ovarian failure and to compare it to that of age-matched normal women. Methods:60 consecutive women with POF and 35 age-matched normal women were examined for dry eye using a standardized technique including slit lamp biomicroscopy, Schirmer tear tests, ocular surface vital dye staining, and tear breakup time. Dry eye symptoms were assessed with the Ocular Surface Disease Indexã (OSDI) and symptom history, and the impact of the symptoms on activities of daily living and visual function was determined with the NEI-Visual Function Questionnaire (NEI-VFQ-25). Results:Significantly more POF patients reported use of lubricant drops (p=0.002), and the following dry eye symptoms: grittiness, foreign body sensation, scratchiness, tearing, blurred vision, burning, tired eyes, itching, photosensitivity and dry feeling (all p values <0.05). POF patients scored significantly worse on every domain of the OSDIã, (all p values < 0.001), on the NEI-VFQ-25 (overall score) and on the ocular pain domain, (p< 0.001). The severity of ocular surface vital dye staining of both the cornea and conjunctiva was significantly greater in POF patients using the Oxford grading scale (all p values < 0.05). Using the van Bijsterveld grading scheme, nearly 20% of POF patients met the diagnostic criteria for dry eye vs. 3 % of normals, (p=0.029). While the mean Schirmer values, with and without anesthetic, and tear breakup times were reduced in most POF patients, these values were highly variable and did not significantly differ from those of the normal controls. Conclusion:Women with POF have evidence of ocular surface disease with an increased prevalence of dry eye symptoms and signs of ocular surface damage as compared to age-matched controls. Dysregulation of sex hormones and immunologic dysfunction as seen in POF may play a role in the pathogenesis of the ocular surface disease seen in this condition. The role of sex hormones in ocular surface homeostasis is further supported by these findings.
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