Hormones & PSC

Hi,

We're interested in the roles of female hormones play in the development and/or worsening of Posterior Subcapsular Cataracts (PSC).

Case in point:

A patient has developed PSC within the last 5 years. But they were mild and non-consequential in affecting vision; therefore they were left alone without concern or medical intervention.

It's causes are relatively unknown, but suspected to be due to long-term usage of corticosteroid creams for the management of atopic dermatits (eczema) skin lesions.

5 years have transpired with no consequence, until the patient started HRT using low oral administered Estradiol Valerate and Cyproterone Acetate. Within one month of HRT administration, the patient's PSC in one eye developed rapidly overnight, and within a week the affected eye was only capable of finger counting VA. Surgery was imminent.

Of importance, is that the PSC deterioration was affecting only one eye, while the other eye did not experience any deterioration of the PSC compared to when it was first discovered 5 years ago.

Since steroid induced cataracts often manifest bilaterally, while this patient experienced only deterioration in one eye, should the HRT be suspected to be the cause of the sudden development?

Similarly, if the patient continues on the exogenous hormones after the cataract surgery, would it be of any consequence to the state of the other currently unaffected eye?

What are the relationships between exogenous hormones and the eye like corneal alterations etc?

Thank you.

[John C Hagan III, MD, FACS, FAAO]

Hormonal replacement therapy (HRT) is not considered a factor in the development of cataracts in general, and posterior subcapsular cataracts in particuliar. PSC often grow very rapidly, some for no good reason.  Possible causes might include: very poor nutrition, heavy use of alcohol/tobacco products, any form of steroid therapy, previous trauma, similiar family hx of PSC, uncontrolled diabetes, radiation treatment through the orbit and BAD LUCK.

If HRT is needed it can be continued. HRT has been associated with dry eyes and migraines.

JCH III MD

[CraziED]

Hi Dr. Hagan,

Thanks for your reply. It's heartening to hear that HRT is not directly correlated to PSC.

However, you did mention that certain form of steroid therapy is associated with PSC. Please elaborate on what kind of steroid therapy (would corticosteroid creams/HRT be of interests?), and what are the possible changes in the eyes occurring when on HRT?

Thanks for your comments.

[John C Hagan]

In order of the most likely to cause cataracts or steroid glaucoma:

steroid eye drops/ointments, oral steroids, inhaled steroids, injected steroids, topical (on the skin) steroids.

Steroid creams would most likely have to be used around the eye for extremely long periods of time (6 months or more) and used around the eye with the mechanism being getting in the eye rather than soaking through the skin into the eye.

For more info follow this link    http://www.bmj.com/cgi/content/full/309/6953/543/a

JCH III MD