Dry Eye Can Develop With Androgen Deprivation Therapy

young man opens red eyes with fingers
young man opens red eyes with fingers.
The prostate cancer treatment approach can affect ocular surface health, a study shows.

Androgen deprivation therapy (ADT) may increase corneal and conjunctival staining scores in tear function tests, and worsen complaints of dry eye in patients with prostate cancer, according to research published in Journal Français d’Ophtalmologie.

Researchers conducted a cross-sectional study to evaluate the effect of systemic ADT on tear function tests and the ocular surface in patients with prostate cancer. 

Men undergoing ADT were recruited at a single center, and all participants underwent a complete ophthalmic examination, including tear film break up time (TBUT), corneal and conjunctival staining, Schirmer 1 test, conjunctival impression cytology, and Ocular Surface Disease Index (OSDI) questionnaire. 

Systemic ADT included the luteinizing hormone-releasing hormone (LHRH) agonists goserelin acetate or leuprolide acetate, and bicalutamide which was added as a second drug in some cases.

The study included a total of 64 participants (69.9±6.4 years; range, 56-83), who were divided into the following groups: ADT for prostate cancer (n=31), only surgical treatment for prostate cancer (n=17), or healthy, age-matched control participants who had never received prostate cancer treatment (n=16). The ADT group was further divided into subgroups based on the number of drugs (1 drug, n=9; or 2 drugs, n=22). 

The researchers found that the mean Schirmer’s values and TBUTs were significantly lower and corneal staining and OSDI questionnaire scores were significantly higher in the ADT group compared with the surgical and control groups (P <.01). The mean Schirmer’s values were 6.87 mm, 11.41 mm, and 13.03 mm in the ADT, surgical, and control groups, respectively (P =.001). The TBUTs were 5.45±2.01, 9.85±2.52 and 9.81±1.96 seconds in the ADT, surgical, and control groups, respectively (P =.001). They did not find a significant difference between the groups in the conjunctival impression cytology results according to the Nelson grading system (P =.422).

In the subgroup analysis, the team found no significant differences between the 1-drug and 2-drug groups for mean OSDI scores, Schirmer’s values, TBUTs, nasal and temporal conjunctival staining rates, and impression cytology results (P >.05 for all). The mean corneal staining grade of patients in the 1-drug was significantly lower than that of the patients in the 2-drug group (P =.043).

“[O]ur results have shown that androgen deficiency is associated with both aqueous-deficient and evaporative [dry eye disease],” researchers explain. “Prospective controlled studies are warranted to evaluate the long-term effects of [ADT] drugs on the ocular surface.”

Limitations of the study included the inability to evaluate and compare dry eye tests and cytology samples before and after patients initiated ADT or underwent prostate surgery, inability to measure serum testosterone levels, and limited sample sizes. 


Aydin Kurna S, Oflaz Hacisalihoglu A, 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