Polycystic Ovary Syndrome and Dry Eye Disease: A Systematic Review and Meta-Analysis

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 (n = 639) was diagnosed using the Amsterdam (n = 2) or Rotterdam (n = 11) criteria. Studies were heterogeneous (I ² > 75%) for all analyzed parameters. OSDI (MD 7.5, 95% CI 1.4 to 13.6, p = 0.02) and invasive TBUT (MD −3.1s, 95% CI −4.7 to −1.6, p < 0.0001) were worse in PCOS whereas Schirmer I (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 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.