Studies show link between dry eye symptoms and contraceptives

Those who use oral contraceptives have improved dry eye symptoms, according to research.

A recent study reported that hyaluronic acid administered in combination with galacto-xyloglucan had a positive effect on subjective dry eye disease symptoms in women who use oral contraceptives. This research team, led by Jose-Maria Sanchez-Gonzalez, OD, PhD, is from the Department of Physics of Condensed Matter, Optics Area, Vision Sciences Research Group, Pharmacy School, University of Seville, Seville, Spain.

The authors of a study1 in J Clin Med explained that the anterior surface of the eye, cornea, conjunctiva, lacrimal gland, and meibomian glands react to changes in estrogen and progesterone and there “appears to be relationships between dry eye symptoms and sex steroid hormones, estrogens, androgens and progestins.”

Among women using oral contraceptives, studies have reported a link between dry eye symptoms and the administration of hormonal contraceptives.2,3 Hyaluronic acid is a prime component in artificial tear formulations, but the effectiveness decreases with time.

Sanchez-Gonzalez and associates evaluated the benefits of combining 0.4% hyaluronic acid and 0.2% galacto-xyloglucan to alleviate the subjective symptoms of dry eye disease and tear film invasive and noninvasive signs.

Galacto-xyloglucan is a glucose polymer that mimics the natural mucosal barrier, protecting the epithelium, and thus limiting the entry of harmful agents, they explained.

The investigators conducted a prospective, longitudinal, single-blind, clinical trial that included 34 young women using oral contraceptives and assessed the results in patients receiving the combination therapy compared with those using hyaluronic acid alone. The participants in both groups completed dry eye disease questionnaires before treatment and after 6 weeks, and the investigators assessed the tear film at the same time points.

The results indicated that the combination treatment resulted in a greater decrease in the ocular surface disease index (17.01 ± 11.36 score points, p < 0.01) than hyaluronic acid alone (11.61 ± 11.18 score points, p < 0.01).

The patients’ subjective evaluation of the combination therapy was higher compared with hyaluronic acid alone, i.e., 4.06 ± 5.50 score points, p < 0.01 and 0.70 ± 3.16, p = 0.21, respectively.

The first noninvasive break-up time (NIBUT) measurement with the combination treatment therapy showed an increase of 1.75 ± 1.16 seconds (p < 0.01) compared with the increase with hyaluronic acid alone of 0.54 ± 1.01 second (p < 0.01). The mean increase in the NIBUT in the combination therapy was 3.72 ± 5.69 seconds (p < 0.01) and in the hyaluronic group, 2.19 ± 5.26 seconds (p = 0.05).

“Hyaluronic acid in combination with galacto-xyloglucan significantly decreased subjective dry eye disease symptoms and increased first and mean NIBUT compared to hyaluronic acid alone," The authors concluded. "Galacto-xyloglucan added efficacy in young-adult childbearing-age oral contraceptive users.”

1. Sanchez-Gonzalez J-M, De-Hita-Cantaleio C, Sanchez-Gonzalez MC. Hyaluronic acid and galacto-xyloglucan eyedrop efficacy in young-adult oral contraceptive users of childbearing age. J Clin Med. 2022; 11:4458;doi:10.3390/jcm11154458
2. He B, Iovieno A, Etminan M, Kezouh A, Yeung SN. Effects of hormonal contraceptives on dry eye disease: A population-based study. Eye. 2022;36:634–638.
3. Chen SP, Massaro-Giordano G, Pistilli M, Schreiber CA, Bunya VY. Tear osmolarity and dry eye symptoms in women using oral contraception and contact lenses. Cornea. 2013;32:423–428.