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Gender and age differences in dry eye prevalence

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Characterised by a lack of sufficient lubrication and moisture on the surface of the eye, dry eye is a prevalent condition that significantly affects quality of life1

Older woman looking up applying eye drops on white background
Dry eye disorder affects 1 in 5 people, with increased prevalence in women than men.Shutterstock.com

Dry eye disease can lead to various symptoms including irritation, redness, discharge, and visual disturbances.1,2,3 Prevalence varies across different genders and age groups and is more commonly observed in older adults and women, especially post-menopausal women.3

PREVALENCE AMONG DIFFERENT DEMOGRAPHICS

  • Gender differences: Research indicates that dry eye disease is more prevalent in women than in men.4 Hormonal fluctuations, particularly oestrogen and androgen, play a significant role in this disparity.3 Oestrogen can influence the lacrimal gland, which is responsible for producing tears,5 and androgen deficiency has been linked to the dysfunction of the meibomian glands in the eyelids, crucial for tear stability.6
  • Age differences: Age is a significant risk factor for dry eye disease.3,4 As people age, the production of tears decreases, and the tear film's stability is compromised. The prevalence of dry eye disease increases notably after the age of 50. This is partly due to general health decline and the increased incidence of comorbidities such as diabetes and rheumatoid arthritis, which are linked to higher rates of dry eye.7

 

OLDER ADULTS AND POST-MENOPAUSAL WOMEN

  • Older adults: The tear film is composed of three layers: lipid, aqueous, and mucous. Each component plays a vital role in maintaining eye health.8 In older adults, there are changes in the composition of these layers, often exacerbated by systemic medications that affect tear production, such as antihistamines and antidepressants.1 Additionally, age-related eyelid changes can lead to increased tear evaporation, further aggravating dry eye symptoms.9
  • Post-menopausal women: For women, menopause marks a significant risk period for developing dry eye disease. The decrease in androgen and oestrogen levels during menopause directly affects the ocular tissues involved in tear production and regulation. Studies have shown that post-menopausal women report higher rates of dry eye symptoms compared to pre-menopausal women and men of the same age group.4,10

 

Understanding the demographic differences in dry eye prevalence helps in tailoring more effective treatment and management strategies. Recognising these variations is crucial in advising and managing care for patients with dry eye disease, especially in older adults and post-menopausal women. Pharmacists can guide patients in selecting suitable OTC products and advise on the potential benefits of systemic treatments like hormone replacement therapy.

REFERENCES

  1. Sheppard J, Shen Lee B, Periman LM. Dry eye disease: identification and therapeutic strategies for primary care clinicians and clinical specialists. Ann Med. 2023 Dec;55(1):241-252. doi: 10.1080/07853890.2022.2157477. PMID: 36576348; PMCID: PMC9809411. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9809411/
  2. Boyd K, Huffman JM, Turbert D. What is Dry Eye? Symptoms, Causes and Treatment. American Academy of Ophthalmology. 22 May 2024. Available from: https://www.aao.org/eye- health/diseases/what-is-dry-eye
  3. Wróbel-Dudzińska D, Osial N, Stępień PW, Gorecka A, Żarnowski T. Prevalence of Dry Eye Symptoms and Associated Risk Factors among University Students in Poland. Int J Environ Res Public Health. 2023 Jan 11;20(2):1313. doi: 10.3390/ijerph20021313. PMID: 36674068; PMCID: PMC9859544. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9859544/#:~:text=Dry%20eye%20disease%20(DED)%20is,of%20the%20tear%20film%20homeostasis
  4. Nijm LM, Zhu D, Hemphill M, Blemker GL, Hendrix LH, Kabat AG, Gibson AA. Does Menopausal Status Affect Dry Eye Disease Treatment Outcomes with OC-01 (Varenicline Solution) Nasal Spray? A Post Hoc Analysis of ONSET-1 and ONSET-2 Clinical Trials. Ophthalmol Ther. 2023 Feb;12(1):355-364. doi: 10.1007/s40123-022-00607-7. Epub 2022 Nov 18. PMID: 36401081;PMCID: PMC9834459. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9834459/
  5. Oprea L, Tiberghien A, Creuzot-Garcher C, Baudouin C. Influence des hormones sur le film lacrymal [Hormonal regulatory influence in tear film]. J Fr Ophtalmol. 2004 Oct;27(8):933-41. French. doi:10.1016/s0181-5512(04)96241-9. PMID: 15547478. Available from: https://pubmed.ncbi.nlm.nih.gov/15547478/#:~:text=The%20eye%20is%20thus%20a,the%20functioning%20of%20Meibomian%20glands
  6. Wang LX, Deng YP. Androgen and meibomian gland dysfunction: from basic molecular biology to clinical applications. Int J Ophthalmol. 2021 Jun 18;14(6):915-922. doi: 10.18240/ijo.2021.06.18. PMID: 34150548; PMCID: PMC8165631. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8165631/
  7. Sharma A, Hindman HB. Aging: A Predisposition to Dry Eyes. Journal of Ophthalmology. 2014 Aug 14;2014(1). doi: 10.1155/2014/781683. Available from:
    https://onlinelibrary.wiley.com/doi/10.1155/2014/781683
  8. Chang AY, Purt B. Biochemistry, Tear Film. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. Available from:
    https://www.ncbi.nlm.nih.gov/books/NBK572136
  9. De Paiva CS. Effects of Aging in Dry Eye. Int Ophthalmol Clin. 2017 Spring;57(2):47-64. doi:1097/IIO.0000000000000170. PMID: 28282314; PMCID: PMC5347479. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347479/
  10. Gorimanipalli B, Khamar P, Sethu S, Shetty R. Hormones and dry eye disease. Indian J Ophthalmol. 2023 Apr;71(4):1276-1284. doi:10.4103/IJO.IJO_2887_22. PMID: 37026259; PMCID: PMC10276676. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10276676/

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