The impact of hormonal contraceptive use on dry eye disease: a literature review

Abstract

Background and objectives. Dry eye disease (DED) is a multifactorial condition that affects ocular surface homeostasis and may cause ocular discomfort and visual disturbance. Although hormonal contraceptives are widely used, their influence on tear film stability and ocular surface health remains debated. This review evaluates the available evidence regarding the association between hormonal contraceptive use and DED. Materials and methods. A structured literature search was conducted in PubMed, ScienceDirect, and Google Scholar for primary studies published in English or Indonesian between 2010 and 2025. Nine observational studies met the eligibility criteria and were included in this review. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools appropriate for cross-sectional, case-control, and cohort studies. Results. The included studies suggest that hormonal contraceptive use may be associated with DED, particularly through effects on tear production, tear film stability, and ocular surface integrity. Some studies reported reduced tear secretion, shorter tear break-up time, increased dry eye symptoms, or ocular surface alterations among hormonal contraceptive users. Evidence also suggests that prolonged hormonal contraceptive use may be associated with histological and cytological changes, including reduced goblet cell density and conjunctival epithelial metaplasia. However, findings were not consistent across all studies. Conclusions. Hormonal contraceptives, particularly oral and combined formulations, may represent potential contributing or exacerbating factors in DED. However, because of heterogeneity among studies and methodological limitations, a definitive causal relationship cannot be established. Further well-designed longitudinal studies are needed to clarify the ocular effects of different hormonal formulations, dosages, durations of use, and delivery systems.

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