Dry eye disease (DED) affects more women than men worldwide, and these individuals are diagnosed at an earlier age. As hormonal contraceptives (HCs) are a known risk factor for DED, researchers decided to determine the association between the two in women of reproductive age.

In this retrospective cohort study—the first population-based work to investigate the association between HCs and DED—a little under five million women in the US between the ages of 15 and 45 were followed for 10 years to the first diagnosis of dry eye. Regular HC users needed to have at least two prescriptions in both the first and second year prior to the index date. Mild cases of dry eye for which only topical lubrication is used were not examined.

The study concludes there was an increased risk of DED in all HCs users, and regular users had a higher risk for DED than irregular users. Among women who used HCs regularly, recent use was associated with a higher risk for DED than past use. In addition, women who took a greater number of different types of HCs were at a higher risk for DED than women who took fewer prescriptions.

“While the exact pathophysiologic mechanism underlying HCs use and DED remains unclear, sex steroid hormones, including estrogens, androgens and progestins, are thought to be implicated in DED pathophysiology,” the authors noted in their study. “Specifically, estrogen receptors are known to be found on meibomian glands, and estrogen administration may promote suppression of meibomian gland function. Estrogen has been reported to decrease the activity, lipid production and size of sebaceous glands.”

He B, Iovieno A, Etmian M, et al. Effects of hormonal contraceptives on dry eye disease: a population-based study. Eye 2021.