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Women with PCOS report worse dry eye symptoms but similar tear volume and stabilityWomen with PCOS May Experience More Dry Eye Symptoms

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Key Takeaway
Note that women with PCOS report worse dry eye symptoms despite having similar tear volume and film stability.

This meta-analysis synthesized data from 13 articles involving 639 women with Polycystic Ovary Syndrome (PCOS) to evaluate dry eye symptomatology and tear film characteristics. The analysis focused on OSDI scores, invasive and noninvasive tear film break-up time (TBUT), and Schirmer values.

Key findings indicate that women with PCOS reported significantly worse OSDI scores (MD 7.5; 95% CI 1.4 to 13.6, p = 0.02) and shorter invasive TBUT (MD -3.1s; 95% CI -4.7 to -1.6, p < 0.0001) than healthy controls. In contrast, Schirmer I values (MD -1.8; 95% CI -4.5 to 0.5, p = 0.12) and noninvasive TBUT (MD -2.1; 95% CI -4.2 to -0.03, p = 0.05) were similar between the two groups.

The authors note significant limitations, including high study heterogeneity (I > 75%) and a low level of certainty regarding the evidence. Clinically, while women with PCOS may experience mild dry eye symptoms, their tear volume and film stability do not differ significantly from healthy controls. Notably, the authors caution that tear film parameters in these women do not typically meet DEWS II criteria for a dry eye disease diagnosis.

How this fits prior evidence

This meta-analysis addresses a gap in understanding the ocular manifestations of Polycystic Ovary Syndrome. While previous coverage noted that mushroom-derived compounds show potential for managing oxidative stress and inflammation in ocular conditions, this study specifically quantifies the symptomatic and physiological differences in dry eye for women with PCOS. It confirms that while symptoms are worse, tear volume and stability are similar to healthy controls.

A review of 13 different studies involving 639 women with Polycystic Ovary Syndrome (PCOS) looked at how the condition affects eye health. Researchers compared the symptoms and tear film characteristics of women with PCOS to a group of healthy women.

The results showed that women with PCOS reported worse dry eye symptoms on standard scales. However, the study found that the actual amount of tear fluid and the stability of the tear film were similar between both groups. This means that while the discomfort of dry eyes may be more noticeable for those with PCOS, the physical volume of tears remains similar to those without the condition.

It is important to note that the evidence for these findings is not very certain because the studies reviewed were quite different from one another. Additionally, the physical tear measurements in women with PCOS did not meet the specific clinical criteria for a formal dry eye disease diagnosis. These results suggest that while symptoms are more noticeable, the underlying tear production is often similar to others.

What this means for you:
Women with PCOS may report more dry eye symptoms, though tear volume remains similar to those without PCOS.

Common questions

Do women with PCOS have different tear volumes?

The study found that tear volume, measured by Schirmer values and noninvasive tear film break-up time, was similar between women with PCOS and healthy controls. While symptoms were worse for those with PCOS, the actual amount of tear fluid produced did not differ significantly between the two groups.

How severe are the dry eye symptoms for those with PCOS?

Women with PCOS reported worse dry eye symptoms on the Ocular Surface Disease Index (OSDI) compared to healthy controls. However, the study noted that these measurements did not meet the specific clinical criteria for a formal dry eye disease diagnosis in most cases.

Is the evidence for this link strong?

The evidence for these findings is currently considered to have a low level of certainty. This is because the studies included in the review were very different from one another, making it harder to draw firm conclusions.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
PURPOSE: The current meta-analysis reviewed the dry eye symptomatology and tear film differences between PCOS and healthy women. METHODS: PubMed, Cochrane Library, and Scopus were searched for prospective/cross-sectional studies on patients with PCOS where at least one tear film parameter or dry eye symptomatology had been tested and compared with healthy controls. The analyzed data were changes in ocular surface disease index scores (OSDI), tear film break-up time (TBUT), Schirmer values, and Meibography. RevMan software was used for meta-analysis, and weighted mean differences (MD) were computed along with GRADE evidence level determination. RESULTS: Thirteen articles were included, and PCOS ( = 639) was diagnosed using the Amsterdam ( = 2) or Rotterdam ( = 11) criteria. Studies were heterogeneous (I > 75%) for all analyzed parameters. OSDI (MD 7.5, 95% CI 1.4 to 13.6,  = 0.02) and invasive TBUT (MD -3.1s, 95% CI -4.7 to -1.6,  < 0.0001) were worse in PCOS whereas Schirmer I (MD -1.8, 95% CI -4.5 to 0.5,  = 0.12) and noninvasive TBUT (MD -2.1, 95% CI -4.2 to -0.03,  = 0.05) were similar between PCOS and healthy controls. Forest plots revealed an overall MD estimate of all parameters to lie close to the null effect line. All studies had a low level of certainty regarding evidence. CONCLUSIONS: Women with PCOS can experience mild dry eye symptoms; however, tear volume and tear film stability are similar in women with PCOS and those without the condition. In most studies, tear film parameters of PCOS women do not meet DEWS II criteria for DED diagnosis, though they are heterogeneous and have low levels of certainty.
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