Benign prostatic hyperplasia (BPH) is one of the most common diseases in older men, affecting 50% between ages 51 and 60 and up to 90% of those 80 and older, according to the most recent statistics. Between previous studies showing BPH as a risk factor for dry eye disease (DED), meibomian gland dysfunction (MGD) being the most common cause of DED and sex hormones playing a role in MGD, researchers decided to examine the characteristics of meibomian glands in individuals with BPH with the use of noncontact meibography.

Forty-four eyes of 44 men with BPH (mean age 76.1) receiving treatment with the alpha-1 blocker tamsulosin and 46 eyes of 46 age-matched control subjects (mean age 75.3) were enrolled. All subjects were assessed by ocular symptom score, lid margin abnormality score, superficial punctate keratopathy score, meiboscore, meibum grade, tear breakup time and Schirmer test values. Male pattern baldness was also graded.

The meiboscore in the BPH group (4.5) was significantly higher than that in the control group (1.8), reflecting loss of meibomian glands. Tear breakup time was significantly shorter (3.6 vs. 5.6 seconds), and Schirmer score was significantly smaller (9.8mm vs. 13.3mm) in the BPH group than that in the control group. However, there were no significant differences in ocular symptoms between the groups. The proportion of men with androgenic alopecia was also higher in the BPH group than in controls.

As androgen deficiency has been implicated in age-related MGD in men and dihydrotestosterone affects gene expression meibomian gland cells, “it is thus possible that changes in the composition of circulating androgens in men with BPH contribute to morphological changes of meibomian glands,” the authors noted in their study. However, while previous studies showed antiandrogen therapy affecting lid morphology and meibum quality, in this study neither of these factors differed between subjects and controls. The men with BPH were treated with an alpha-1 blocker rather than antiandrogen, making it possible that these results reflect the effects of that treatment, according to the authors.

“Given that a1 blockers have been found to give rise to intraoperative floppy iris syndrome as an adverse effect, treatment with these drugs might promote MGD, although they might also be expected to affect subjective ocular symptoms,” which wasn’t shown in this study. 

Shimizu S, Arita R, Kawashima M, et al. Morphological Changes of Meibomian Glands in Men With Benign Prostate Hyperplasia. Cornea 2021;40:445-448.