In 2002, Sullivan, and his co-workers at Harvard, linked testosterone deficiency to dysfunction of the lacrimal glands (tear ducts). They found that testosterone deficiency increases the dysfunction of certain tear ducts, alters the lipid profile of the tears produced and contributes to evaporative dry eye in women with Sjogren’s syndrome. But are people without Sjogren’s syndrome at increased risk for dry eye if they are deficient in testosterone?
When men were treated with anti-testosterone drugs for prostate cancer, researchers found that men experienced the same symptoms of dry eye including insufficiency of the tear ducts and tear film instability caused by changes in the amount of lipids (oils) in the tears.
We have identified a potential cause of dry eye. What is the solution? Topical testosterone cream placed on the eyelids? In 2004, Conner performed a study in which they applied 3% topical testosterone cream to the eye lids of patients with chronic dry eye twice daily. The study contained about 88% females and 12% males. 21 out of 40 patients in the study were successful in treating their dry eye. Several more subjects reported a benefit from treatment but showed no objective improvement. The successful group was slightly younger than the unsuccessful group (50 years for the successful group vs. 58 years for the unsuccessful group).
So who is a candidate for topical eye-lid testosterone therapy for treating dry eye? Obviously, first, you have to suffer from dry eye. Next, it helps to be closer to 50 than 60, but that is not an absolute indicator of success or failure. Next, you should have either documentation of low testosterone or have clinical symptoms of low testosterone including low libido, decreased muscle mass, decreased energy or any of the other symptoms of low testosterone. Ladies, once you go through peri-menopause and menopause, if you are not on testosterone replacement therapy, you are almost going to certainly have low testosterone levels. Men, it is a little more complicated. Some men in their 20’s have low testosterone level, while some men in their 70’s have normal levels, so you have to rely on your symptoms.
If you have further questions on topical testosterone therapy to treat dry eye, don’t hesitate to call. We may be able to help!
by Dave Miller, RPh, PhD, FIACP
1. Sullivan DA, Sullivan BD, Evans JE, Schirra F, Yamagami H, Liu M, Richards SM, Suzuki T, Schaumberg DA, Sullivan RM, Dana MR. Androgen deficiency, Meibomian gland dysfunction, and evaporative dry eye. Ann N Y Acad Sci 2002 Jun;966:211-22
2. Kathleen L. Krenzer, M. Reza Dana, M. David Ullman, Jennifer M. Cermak, Dorothy B. Tolls, James E. Evans and David A. Sullivan. Effect of Androgen Deficiency on the Human Meibomian Gland and Ocular Surface. The Journal of Clinical Endocrinology & Metabolism December 1, 2000 vol. 85 no. 12 4874-4882
3. C.G. Connor In 2004, Retrospective Analysis of Dry Eye Patients Using 3% Transdermal Testosterone Cream. Invest Ophthalmol Vis Sci 2004;45: E-Abstract 3899.