• Cornea/External Disease

    Review of: Effects of hormonal contraceptives on dry eye disease: a population-based study

    He B, Lovieno A, Etminan M, et al. Eye, March 2022

    In this study, women of child-bearing age were more likely to develop dry eye disease when they took hormone contraceptives, with regular users and those who used multiple types demonstrating higher risk than irregular users.

    Study design

    This case-controlled, retrospective cohort study used the ambulatory electronic medical record database, AQIVA, charting nearly 5 million women aged 15-45 who were followed for the diagnosis of dry eye disease between 2008 and 2018.


    There was an increased risk of developing dry eye disease among hormone contraceptive users. Regular hormone contraceptive users demonstrated a higher risk for dry eye disease than irregular users. Also, women who took more types of hormonal contraception had greater than 2 times the risk of developing dry eye disease.


    In this study, qualification as a patient with dry eye disease required a series of ICD-9 codes for dry eye in addition to receiving at least 2 prescriptions of cyclosporin or lifitegrast within 60 days of the first dry eye code. This does not capture a wide variety of dry eye patients. Additionally, “dry eye” is an umbrella term and this study does not differentiate between aqueous deficient or evaporative loss, or any other category of dry eye. This study did not assess for contact lens use, screen time, or refractive surgery. This study carries the typical limitations of a retrospective study using claims data.

    Clinical significance

    Women are disproportionally affected by dry eye. There are conflicting data with regard to the subjective and objective findings in younger women on hormonal contraception. This is the first population-based study to investigate the association of dry eye disease with the duration of and quantity of hormonal contraceptive use. The relationship between dry eye and hormone replacement therapy is unclear.