Association between serum levels of testosterone and estradiol with meibomian gland assessments in postmenopausal women
Reviewed by Wai Siene Ng

This study aims to reveal any correlation between serum levels of testosterone and estradiol in postmenopausal women with meibomian gland dysfunction. Postmenopausal subjects were defined as amenorrhoea for at least one year with low follide stimulating hormone (FSH) and estradiol. Exclusion criteria include ocular surgery within the previous year and any anterior segment disease. However, women on hormone replacement therapy were included. To demonstrate any effect from this a subgroup analysis was performed which showed no difference. Meibomian gland assessments included in the study were expressibility of meibum, meibum quality, meibomian gland dropout by and lipid layer thickness by spectral interferometry. Estradiol and testosterone serum levels were taken from venous blood samples. However, the time of blood sampling was not described which may be pertinent due to the diurnal variations of hormones and their well-reported bias effect if not taken into account. The authors also proceed to divide the cohort into dry eye or normal based on a Schaumberg questionnaire. However, as the questionnaire relies on the patient self-reporting a diagnosis of dry eye, its validity is questionable. The only objective outcome in the meibomian gland assessments was lipid layer thickness. However, this returned a contradicting result with the dry eye group having a thicker lipid layer. The rest of the assessments were subjective and lacked assessor method description and validation. Hence, it comes as no surprise that there was no significant difference found in estradiol levels and testosterone levels for dry eye of meibomian gland assessment apart from that seen between severe and mild meibomian gland dropout cases and increased testosterone levels. Overall, the study attempts to address the relation between postmenopausal dry eye and meibomian gland dysfunction with estradiol and testosterone with in depth meibomian gland analysis. Improvement in the diagnostic criteria for dry eyes and consistent times for obtaining blood samples may help reveal subtle associations between sex hormones and postmenopausal dry eyes in future studies. 

Association between serum levels of testosterone and estradiol with meibomian gland assessments in postmenopausal women.
Ablamowicz AF, Nichols JJ, Nichols KK.
INVESTIGATIVE OPHTHALMOLOGY AND VISUAL SCIENCE
2016;57:295-300.