Androgen replacement

Optometric Management, Sep 2000 by Hom, Milton M

Can low androgen levels affect your dry eye patients?

Believe it or not, your dry eye patients may be suffering from a lack of hormones. Recent research has indicated that androgen deficiency is a critical factor in dry eye syndrome.

To help compensate for a patient's lack of androgen, some practitioners are using this hormone as a treatment for the ocular surface to promote both lacrimal and meibomian gland function.

The use of androgen in treating dry eye syndrome is still considered experimental, and is currently being investigated by Allergan.

However, this experimental treatment could be an additional option to help your patients who

High Viscosity Artificial Tears

The products in this category are excellent for treating moderate to severe dry eyes. Due to their high viscosity, a few patients using these products may have short-lasting blurring of vision on instillation. This sometimes makes these products inconvenient for frequent daytime dosing.

Here are some high-viscosity artificial tear products: are suffering from dry eye.

For instance, Dr. Warren

Cross of Houston was a compound hyperopic soft contact lens wearer who was asymptomatic until 5 years ago. Since that time, he has experienced severe contact lens intolerance related to dry eyes.

Ketorolac tromethamine (Acular PF), olopatadine hydrochloride (Patanol), diclofenac sodium (Voltaren), use of artificial tears 10 to 15 times a day, oral nonsteroidal anti-inflammatory drugs (NSA)Ds) and punctal occlusion all proved ineffective. At times, the pain was so great and the symptoms so severe and debilitating, that he couldn't talk.

His androgen levels were measured and found to be low. He started taking natural hormonal replacement therapy in the form of a cream. A small amount of the cream was applied to the skin around the eyes once a day, 6 times a week. The cream helped alleviate his dry eye symptoms.

Cross attributes the dry eye and lowered androgen levels to the cholesterol-lowering drugs he'd been taking.

However androgen replacement does have inherent risks. One significant side effect is that prostate cancer is androgenresponsive.

Undiagnosed prostate cancer may continue to grow in a patient who's undergoing androgen replacement therapy.

Prolonged use of high doses of androgen has also been associated with the development of liver disorders, like peliosis hepatis, cholestatic jaundice and hepatic neoplasms, including hepatocellular carcinoma. Peliosis hepatis can be a life-threatening or fatal complication.

Allergan is currently developing topical androgen. It may serve as a safe and effective therapy for the treatment of dry eye in Sjogren's syndrome, as well as other conditions.

Sullivan D.A., Wickham LA., Rocha E.M., et.al. Androgens and Dry Eye in Sjogren's Syndrome. Ann N Y Acad Sci 1999 Jun 22; 876: 312-24.

Cross W.D. Managing the Ocular Surface to Reduce Contact Lens Intolerance. Audio Digest Ophthalmology, May 7, 2000; 38:9.

Androgen Replacement Therapy For Male Hypogonadism. Power-Pak CE. Program no. 424-999-96001-H01. http://www.powerpak.com/ce/Androgen/ lesson.htm

Artificial Tear Ointments

Almost all of the ointments have the same ingredients- petroleum and mineral oil. I think this is the class of artificial tears which is most underused. Patients respond well to them and their dosing - usually at bedtime - is easy for patients to comply with. Many O.D.s use them only in cases of severe dry eye, but I tend to use them even in milder cases.

Here are some artificial tear ointments:

Dr. Hom practices in Azusa, Calif. He's also the author of the Manual of Contact Lens Prescribing and Fitting with CD-ROM Second Edition (Butterworth-Heinemann).