Anti-Androgen Drugs Worsen Dry Eye Disease in Patients With Prostate Cancer

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Anti-androgen drugs may affect the ocular surface because ocular tissues are target sites for androgen action.

Anti-androgen drugs worsen dry eye disease (DED) symptoms in patients with prostate cancer, according to research published in Journal Francis d’ Ophthalmologie. 

Researchers enrolled 64 men (mean age 69.9±6.4 years) in the study and divided them into 3 treatment groups: those taking an anti-androgen drug for prostate cancer (n=31, group A), those receiving surgery for prostate cancer (n=17, group B) and aged-matched control group participants who had never received anti-androgen treatment n=16, group C). They divided group A into 2 subgroups based on the number of medications they were taking (group A1: 1 drug, n=9; group A2: 2 drugs, n=22).

The team excluded patients who had a history of eye surgery or trauma, wore contact lenses, had previous DED or blepharitis, used topical ocular drugs within the last 3 months, used systemic medications that might promote DED, or had any systemic disease that may cause DED.

Investigators performed ocular surface examinations on all participants including tear break up time (TBUT), corneal and conjunctival staining, Schirmer 1 test (SCH 1), conjunctival impression cytology, and administered an ocular surface disease index (OSDI) questionnaire.   

Researchers found that group A demonstrated a significant increase in corneal fluorescein and inferior bulbar conjunctival staining, and a decrease in TBUT and SCH 1 values compared with groups B and C (P <.01). Corneal staining grades were higher in group A2 compared with group A1 (P =.043). OSDI scores were higher in group A compared with groups B and C, which correlated with an increase in complaints including itching, pain, and photophobia (P <.01).

The team recorded higher OSDI scores for group B participants compared with group C (17.90±12.49 vs 12.00±4.13). They also noted lower SCH 1 results (11.41±3.54 vs 13.03±2.29 mm) and higher degrees of mild level nasal staining. They did not observe any statistically significant differences in TBUT. 

The investigators determined that duration of drug usage was not correlated with corneal and conjunctival staining scores or other dry eye parameters and noted no statistically significant differences in conjunctival impression cytology between any of the groups (P =.442).

“Ocular tissues are among the target sites for androgen action,” according to the researchers. They highlight the fact that drugs designed to block the effects of androgen hormones could affect the ocular surface because “androgens promote lipogenesis and suppress keratinization within the meibomian gland and exert a considerable impact on the structure and function of the lacrimal gland, including its cellular architecture, gene expression, protein synthesis, immune activity, and fluid and protein secretion.”

Study limitations include a small sample size, the inability to evaluate dry eye parameters before and after initiating anti-androgen drug therapy or prostate surgery, and a failure to measure serum testosterone levels.


Kurna SA, Hacisalihoglu AO, Altun A, et al. Effects of systemic anti-androgen drugs on the ocular surface. J Fr Ophtalmol. Published online April 27, 2022. doi:10.1016/j.jfo.2021.06.007