Objective: To investigate the effects of chronic obstructive pulmonary disease (COPD) in dry eye status in males and whether the hypoandrogenic status has any concomitant impact.
Methods: Eighty patients with stable COPD and individually matched healthy volunteers on the basis of body mass index (BMI), age, and sex were enrolled. Ocular surface testing included ocular surface disease index (OSDI) questionnaire, evaluation of meibomian gland dysfunction (MGD), tear fluorescein break-up time (TF-BUT), ocular surface staining with lissamine green (LG), Schirmer test with topical anesthesia and Sirius meibographic analysis of meibomian gland area (MGA) loss. Bioavailable testosterone and free testosterone (fT) were measured through the measured total testosterone (TT), albumin, and sex hormone binding globulin (SHBG) concentrations.
Results: Patients with COPD had lower levels of circulating androgens, decreased TF-BUT and Schirmer score and increased LG staining score, MGD grade and MG area loss compared to healthy controls (p<0.01). Forced expiratory volume in 1-second (FEV1), FEV1/forced expiratory vital capacity (FVC) and circulating androgen levels were inversely correlated to OSDI score, LG staining, MGD grade and MGA loss and showed positive correlation with TF-BUT and Schirmer score in patients with COPD (p<0.01). However, when adjusted for androgen levels, FEV1 and FEV1/FVC ratio showed a negative correlation with Schirmer score (p<0.05).
Conclusion: Males with COPD had worse tear film parameters, and this finding was more notable in patients with lower androgen levels. Hypoandrogenic status in patients with COPD attributes to dry eye status of the patients independent of their FEV1 and FEV1/FVC status.