Impact Of Cyclical Variation Of Hormones On Ocular Surface Health And Wound Healing

Hormones have been known to drive inflammatory changes in the body. Since the ocular surface expresses estrogen receptors and is responsive to this hormone, its cytokine milieu is expected to show variations during the menstrual cycle. We investigated the status of tear fluid concentrations of various inflammatory cytokines at three different phases of the menstrual cycle in healthy female subjects.

Tertiary Eye Care Hospital

15 healthy women aged 25-35 years with regular menstrual cycles were prospectively evaluated. Schirmer test scores (ST-1), Non-Invasive Break Up Time (NI-BUT) were assessed during follicular phase(FP),Ovulation phase(OP) and Luteal phase(LP). Tear fluid collected using Schirmer strips in the three different phases was used to measure the levels of interleukin (IL)‐1β, IL‐10, IL‐6, IL‐17A, tumor necrosis factor‐α (TNFα), MMP9, soluble intercellular adhesion molecule 1 (sICAM1), and vascular endothelial growth factor‐A (VEGF‐A) using a microfluidic cartridge‐based multiplex ELISA kit (Bio‐M Pathfinder, NovoMol‐Dx, India, a customized version of the EllaTM Automated ELISA system, Bio‐Techne® Corporation, Minnesota, USA).

ST-1 and NI-BUT were reduced during the OP compared to FP. A significantly higher number of subjects showed increased tear levels of inflammatory cytokines, IL-6, IL-1b, and VEGF-A during OP and LP compared to FP. 50% of subjects showed an increase in MMP9 in OP and LP compared to FP.

 Majority of subjects showed an increase in tear fluid inflammatory cytokine levels during the ovulatory and luteal phases. The variability in ocular surface inflammatory milieu during menstrual cycle may impact various disease conditions including dry eye disease and post-surgical wound healing, and many other ocular surface functions that are influenced by these cytokines. These findings indicate the relevance of menstrual cycle during disease monitoring and/or treatment planning.