Treatment of menopausal keratoconjunctivitis sicca with topical oestradiol

Abstract

Objective To investigate the effect of 17β‐oestradiol ophthalmic drops in comparison with a traditional Design Randomised prospective trial. Setting Menopause clinic. Participants Eighty‐four postmenopausal women suffering from keratoconjunctivitis sicca and necessitating a hormone replacement therapy (HRT) for general climacteric symptoms. Methods The women were randomised into two groups and were given 17β‐oestradiol eye drops (n=42, group 1) or a tear substitute (n=42, group 2). Both groups received a systemic HRT. Main outcome measures A Schirmer's test was performed immediately before the beginning of therapy and after four months. In addition, eye symptoms were assessed using a visual analogue scale. Results A comparison of visual analogue scores at four months in the women who received 17β‐oestradiol eye drops versus those who received a tear substitute demonstrated a statistically significant difference in all observed ocular symptoms (P<0.0001) The Schirmer's test revealed a significant difference of results before and after treatment in the oestradiol group (P<0.0001) while in group 2 no significant difference was found. Conclusions Our study demonstrates that topical oestrogen is successful in treating keratoconjunctivitis sicca while it seems that the blood‐eye barrier prevents systemic oestrogens from acting on the conjunctivae.