Ocular Changes in PCOS: The Indirect Impact

Introduction:

Hormonal changes in the body can influence one’s eyesight. The sex hormone estrogen, in particular, can make the cornea more elastic, affecting the light's overall path through the eye. Such discrepancies could potentially result in blurry vision.

Hence, hormonal changes during menopause or perimenopause could also cause vision fluctuations. Polycystic ovary syndrome (PCOS) is a hormonal condition that results from the imbalance of reproductive hormones such as androgens. While hair loss is more common with PCOS, ocular problems could also occur in women with such conditions, affecting vision quality and tear drainage.

What Is Polycystic Ovarian Syndrome?

Polycystic ovary syndrome (PCOS) describes the formation of small, numerous fluid-filled sac-like structures called cysts in the ovaries. Polycystic ovary syndrome is a condition characterized by the abnormal production of androgen (male sex hormones present in lesser amounts in women) by the ovaries.

Nevertheless, cysts cannot be seen in some cases, while cysts can be developed in some women without this condition. The women with this condition have heightened concentration of androgen in the body compared to the healthier individuals. This can cause problems with menstruation or menstrual cycle. PCOS can show a range of clinical manifestations.

The most common symptoms of polycystic ovarian syndrome include the following.

• PCOS often leads to irregular periods or a lack of menstruation.

• Women with PCOS may experience difficulties with ovulation, affecting fertility.

• Elevated levels of male hormones (androgens) can cause symptoms such as acne, excessive facial or body hair (hirsutism), and male pattern baldness.

• Enlarged ovaries with small fluid-filled cysts may be visible on ultrasound.

• Many women with PCOS are more likely to have insulin resistance, potentially resulting in weight gain, an increased possibility of type 2 diabetes, and challenges with losing weight.

• Skin issues like acne, darkening of the skin (acanthosis nigricans), and skin tags may be present.

• PCOS has been associated with cognitive health impairments and significant mood disorders such as depression and anxiety.

• There is also an elevated risk of sleep health concerns and sleep apnea in women with this condition.

Can PCOS Cause Ocular Changes?

Polycystic ovary syndrome chiefly affects the endocrine and reproductive systems. However, it is known that PCOS can have indirect influences on other parts of the body. So, PCOS can show indirect effect on the eyes. PCOS itself is not thought to result in ocular changes directly. In contrast, the associated conditions of PCOS, including hormonal imbalance and insulin resistance, can potentially result in eye-related concerns. They include blurred vision, dry eyes, and vision problems.

What Are the Ocular Changes Associated With PCOS?

Ocular changes associated with polycystic ovary syndrome could be indirectly related to the hormonal imbalances and metabolic dysfunctions seen in women with PCOS. the potential ocular changes and eye health problems seen in women with PCOS include the following.

• Dry Eye Syndrome: Dry eye syndrome or dry eyes affects the layers of the tears covering the corneal tissue. So, it affects the tear film (the three layers of tears) that cover and protect the ocular surface. Dry eyes from the disruption to the tear film can cause itching, burning, excessive tears, and blurred vision. People with dry eyes also experience a feeling of something stuck inside their eyes. Hormonal imbalances in PCOS, especially androgen level fluctuations, can affect eye tear production, resulting in dry eyes.

• Blurred Vision: Blurred vision generally refers to decreased sharpness and clarity. It is not a condition, while blurred vision is one of the manifestations of a range of ocular diseases. Changes in blood sugar concentration from insulin resistance can result in vision fluctuations. Insulin resistance is the most commonly seen in women with polycystic ovary syndrome.

• Glaucoma: Glaucoma is a group of eye health conditions that result in total blindness and vision impairment due to damage in the nerve in the back portion of the eye called the optic nerve. Glaucoma is of two types, namely open-angle and angle-closure glaucoma. The open-angle is the most common form and remains asymptomatic other than gradual degrees of vision loss. Angle-closure glaucoma is a rare type and is considered a medical emergency. The symptoms include eye pain, eye discomfort, and nausea with acute vision loss. Certain studies have shown a potential link between PCOS and increased risk for the development of glaucoma.

• Migraine: Migraine is a neurological condition typically characterized by a painful headache. The headache could be manifested as a severe throbbing pain or a feeling of pulsation, specifically on one side of the head. Such throbbing pain on one side of the head varies in intensity. A migraine generally occurs due to any abnormal brain activity that temporarily affects the chemical messengers, electrical nerve signals, and the related blood vessels of the brain. The headache generally occurs in episodes and is often accompanied by nausea, sensitivity to light, sensitivity to sound, vomiting, fatigue, lack of appetite, and mood changes. Some females with PCOS encounter migraines, causing certain visual disturbances.

• Retinal Abnormalities: The retina is the sensitive layer present at the back portion of the eye. The studies show that there could be an increased risk of retinopathy (diabetic retinopathy) in women with polycystic ovary syndrome. Retinopathy is more common in PCOS women with suspected diabetes or insulin resistance.

How Are Ocular Changes in PCOS Addressed?

Ocular changes associated with polycystic ovary syndrome (PCOS) are not typically a direct symptom of the condition. However, hormonal imbalances in PCOS may indirectly affect eye health. Addressing these concerns generally involves managing the underlying hormonal issues and adopting good overall health practices.

• Since PCOS involves hormonal imbalances, addressing these imbalances through medications or lifestyle changes may indirectly improve ocular symptoms.

• Detecting and treating eye conditions early can prevent complications.

• Adopting a healthy lifestyle, including regular exercise, a balanced diet, and managing stress, can positively impact hormonal balance and overall well-being, potentially benefiting ocular health.

• Some women with PCOS may experience dry eye symptoms. Using artificial tears, maintaining proper hydration, and avoiding prolonged screen time can help manage dry eyes.

Conclusion:

It is crucial to note that the ocular health changes are not the direct consequences of polycystic ovary syndrome. However, it is linked to the underlying and rudimentary problems associated with PCOS. They include hormonal disruptions and metabolic declines. Managing such ocular problems requires treatment for both eye and hormonal problems. If one has PCOS and is encountering eye-allied problems, then it is vital to consult the ophthalmologist and general practitioner. Determining the underlying cause and getting appropriate treatment options will be helpful. Moreover, regular eye examination is integral to monitoring any PCOS-related eye problems.