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Minniti D., Candela V.
Dipartimento delle Specialità Chirurgiche Sezione di Oftalmologia, Policlinico “G. Martino” Università degli Studi di Messina, Messina
Alteration of the ocular surface due to changes in estrogen turnover accompanying postmenopause results from hypolacrimia or dry eyes, i.e. a defect in the aqueous component of tears or a quantitative and qualitative change in other lacrimal components, leading to the loss of fiber elasticity, with thinning and degeneration of the conjunctival and corneal epithelia, as well as partial occlusion of tear ducts with a finely foamy secretion. Various questionnaires have been developed to evaluate the severity of the condition in relation to the patient’s quality of life, including the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and the Ocular Surface Disease Index (OSDI), which measure the quality of life in relation to the quality of vision and evaluate symptoms of ocular surface disease. Controversy surrounds the effect of hormone replacement therapy on the ocular surface, some claiming that estrogen replacement relieves eye discomfort symptoms, others reporting that it is responsible for the development of dry eye in the long term. To shed light on this debate, this article comments on studies investigating the importance and efficacy of hormone replacement therapy in relation to morphologic changes of the conjunctival epithelium.