Immunological Impact of Sex Hormones at Ocular Surface: A Narrative Review

Relationship between sex hormones and ocular surface immunity is controversial. Estrogens, androgens, and progesterone, play pivotal roles in modulating immune responses on the ocular surface. Estrogens exhibit dual roles, acting as both pro-inflammatory and anti-inflammatory agents depending on their concentration and receptor interaction, while androgens generally demonstrate immunosuppressive effects. Progesterone, though less studied, may have immunomodulatory properties. Despite numerous studies, the exact molecular pathways through which sex hormones regulate ocular immunity are not fully understood, and findings often appear inconsistent. To address these gaps, a comprehensive literature search was conducted across PubMed, Scopus, and Web of Science, focusing on keywords related to sex hormones, immunity, and ocular surface health. The aim is to summarize hormone receptor mechanisms, their influence on immune cell function and production of inflammatory mediators at the ocular surface. Overall, this review highlights the intricate interplay between sex hormones and ocular surface immunity, emphasizing that hormonal balance is essential for maintaining ocular health. A deeper understanding of these mechanisms could drive the development of novel, hormone-based therapeutic strategies for inflammatory ocular disorders, such dry eye disease, meeting an urgent clinical need.