Focus on sex hormone axis disorder: exploring the susceptibility mechanism of dry eye in perimenopausal women

Dry eye (DE) is a disease that affects the ocular surface in multiple aspects. The main feature of this disease is the disruption of tear film balance. If not effectively controlled, DE can cause ocular discomfort, pain and visual impairment. These problems will seriously affect patients’ quality of life. Perimenopausal women are at extremely high risk of DE, and their pathogenesis and risk factors have distinct stage specificity. The core view is that the disorder of sex hormones caused by ovarian failure is the initial and core link leading to the imbalance of tear film homeostasis. On this basis, chronic immune inflammatory response, neuroendocrine changes, perimenopausal depression, sleep disorders and the use of specific drugs such as hormone replacement therapy (HRT), as important contributing factors, further amplify the risk of disease in this group. Through a comprehensive analysis of these multi-level and intertwined risk factors, this review emphasizes the need for individualized management strategies for the prevention and treatment of DE in perimenopausal women, so as to provide theoretical basis and new ideas for the standardized clinical diagnosis and treatment of DE in perimenopausal women.