Impact of Estrogen Deficiency on Dry Eye Disease in BRCA Mutation Carriers With Premature Menopause

PURPOSE: Dry eye disease is a multifactorial disorder of the ocular surface in which tear film homeostasis is disrupted, and hormonal status is among the contributing factors. BRCA mutation carriers often undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) or receive aromatase inhibitors (AIs), both leading to estrogen deprivation. This study examined how estrogen deficiency affects dry eye disease parameters. METHODS: Ninety women aged 40 to 50 years were enrolled: those treated with RRBSO (n = 30), those receiving AIs (n = 30), and healthy controls (n = 30). Tear break-up time (TBUT), Schirmer test score, and Ocular Surface Disease Index were measured. Intergroup differences were assessed using ANOVA with post hoc testing. RESULTS: Both estrogen-deprived groups had significantly shorter TBUT and lower Schirmer scores than controls (all P < 0.01). Ocular Surface Disease Index scores were highest in the RRBSO group, intermediate in the AI group, and lowest in controls (all P < 0.0001). No significant TBUT or Schirmer score differences were observed between the RRBSO and AI groups. CONCLUSIONS: Estrogen deficiency, whether surgical or pharmacological, is linked to impaired tear film stability, reduced tear production, and higher symptom burden in BRCA mutation carriers. RRBSO is associated with the greatest symptom severity, emphasizing the need for proactive ocular surface monitoring and tailored management in this population.