Changes in tear film, corneal topography, and refractive status in premenopausal women during menstrual cycle

To investigate the changes in a questionnaire based subjective symptomatology, tear film break-up time, tear volume, corneal topography, and refractive status in premenopausal women during menstrual cycle.

Seventeen premenopausal females and 15 healthy males were enrolled in this prospective study. After routine ophthalmologic examination, an ocular surface disease index questionnaire was administered, tear film break-up time (TBUT), and Schirmer I tests were performed. Keratometry readings and refractive status were also obtained. All examinations were repeated at day 21, day 12 and day 2.

OSDI score in day 21 was significantly lower than that in day 12 (p=0.004) and day 2 (p=0.01) in the female patients; however, no significant change was found in the male subjects (p>0.05). No statistically significant difference was found in TBUT and Schirmer I tests, keratometry, and refraction results in both of the female and male subjects at all of the test points (p>0.05). There was a significant correlation between OSDI score and TBUT (p=0.02, p=0.03, respectively), and Schirmer I test at day 12 (p=0.004, p=0.008, respectively). A significant negative correlation was found between oestrogen level and horizontal keratometry values at day 21 (r=-0.5, p=0.03; r=-0.4, p=0.04, respectively) for the right and left eyes in the female subjects.

Our study confirms that fluctuations in the blood levels of oestrogen produce alterations in ocular surface equilibrium during the menstrual cycle and consequently affect the subjective dry eye symptoms in female patients. However, no ocular surface parameter changes were observed.