TREATMENT OF MENOPAUSAL KERATOCONJUNCTIVITIS SICCA WITH TOPICAL ESTRADIOL

Objective To investigate the effect of 17 beta-oestradiol ophthalmic d rops in comparison with a traditional tear substitute in postmenopausa l women with keratoconjunctivitis sicca. Design Randomised prospective trial. Setting Menopause clinic. Participants Eighty-four postmenopau sal women suffering from keratoconjunctivitis sicca and necessitating a hormone replacement therapy (HRT) for general climacteric symptoms. Methods The women were randomised into two groups and were given 17 be ta-oestradiol eye drops (n = 42, group 1) or a tear substitute (n = 42 , group 2). Both groups received a systemic HRT. Main outcome measures A Schirmer's test was performed immediately before the beginning of t herapy and after four months. In addition, eye symptoms were assessed using a visual analogue scale. Results A comparison of visual analogue scores at four months in the women who received 17 beta-oestradiol ev e drops versus those who received a tear substitute demonstrated a sta tistically significant difference in all observed ocular symptoms (P < 0.0001) The Schirmer's test revealed a significant difference of resu lts before and after treatment in the oestradiol group (P < 0.0001) wh ile in group 2 no significant difference was found. Conclusions Our st udy demonstrates that topical oestrogen is successful in treating kera toconjunctivitis sicca while it seems that the blood-eye barrier preve nts systemic oestrogens from acting on the conjunctivae.