Sex plays a large role in the symptoms of dry eye disease, according to a study. In a large cohort, women had significantly higher symptom scores and a lower correlation between signs and symptoms than men.
Dry eye disease is more prevalent in women. The recent TFOS DEWS II report confirmed that sex and hormones play an important role in the regulation of the ocular surface and adnexa. A study carried out in the Netherlands used a large tertiary dry eye clinic’s database to further explore the role of sex in dry eye disease.
Symptoms and their impact on vision were assessed through the Ocular Surface Disease Index questionnaire. Dry eye tests, including tear osmolarity, Schirmer, corneal and conjunctival staining, tear breakup time and meibomian gland dysfunction, were performed in both eyes and graded according to a severity score between 0 and 1.
A total of 755 patients with dry eye disease, mostly women, were included. Women, on average, had a higher score for symptoms and higher score for signs in most of the tests performed. Further analysis showed that they had a 40% higher symptom score than men in the mild to moderate signs groups, while this difference was not significant in the severe signs group.
Women had significantly lower correlation between symptoms and signs, frequently associated with higher sensitivity and lower pain tolerance tested by a heat stimulus on the forearm. These findings show that “dry eye involves more than the ocular surface alone,” the authors wrote. The low correlation between signs and symptoms might point toward a diagnosis of neuropathic dry eye, a new subcategory validated by the TFOS DEWS II report.
Comorbidities and the greater willingness of women to report pain as compared with men might further explain this imbalance.
“In conclusion, this study found that sex has an important effect on the clinical characteristics of DED. This finding has important consequences for the interpretation of outcomes in both clinical practice and clinical studies,” the authors said. – by Michela Cimberle