Author
Information
Niphadkar
M*, Parulekar SV**
(*
Third Year Resident, ** Professor and Head, Department of Obstetrics
and Gynecology, Seth G S Medical College & KEM Hospital, Mumbai,
India.)
Abstract
Premenstrual
syndrome (PMS) is extremely common in all age groups but more common
in the age group of 30-45 years. Its prevalence is found
to be ranging from 5 to 95%. PMS comprises of a wide spectrum of
physical, psychological and psychosomatic symptomatology. Cyclical
conjunctivitis is one such rare symptom of PMS. We report a case of a
34 year old patient with cyclical conjunctivitis occurring 7-10 days
before menses and then resolving spontaneously after each menstrual
cycle.
Introduction
Premenstrual
syndrome (PMS) is extremely common in all age groups but more common
in the age group of 30-45 years.[1] PMS includes a wide
array of symptoms. The most common physical symptoms are myalgia,
abdominal bloating, fatigue, and headache, found in about 50-95%
cases of PMS.2 The most commonly found behavioural
symptoms in PMS are depressed mood, mood lability causing mood
swings, increased irritability, increased appetite, forgetfulness.
The more severe form of PMS that may interfere with the normal daily
life is called premenstrual dysphoric disorder (PMDD). Many
interesting theories have been put forth regarding the
pathophysiology of PMS. But the current evidence shows that PMS or
PMDD is a result of abnormal or exaggerated cyclical variations in
the levels of ovarian steroid hormones on the central
neurotransmitter mechanisms.[2] Serotonin particularly plays an
important role in its pathophysiology. Ophthalmic conditions
associated with PMS include puffy eyes, blurred vision, sensitivity
to light, sties, and poor vision and cyclical conjunctivitis. [Cool
Press. PMS Symptoms. Available at:
http://coolpress.com/what-are-pms-symptoms/] Cyclical conjunctivitis
is a very rare form of PMS. We present a case of cyclical
conjunctivitis occurring premenstrually.
Case
report
A
34 year old P1L1 came to the OPD with complaints of pain in lower
abdomen and redness of both eyes 7-10 days before every menses for 2
years. The redness and discomfort in the eyes would spontaneously
relieve after menses, only to recur before next menses. The patient
was examined and on examination was found to have pelvic inflammatory
disease. Appropriate antibiotics were prescribed. Thyroid function
tests were advised in view of a mild thyroid swelling. The patient
was told to follow up when the redness of the eyes occurs. The
patient followed up eventually and it was found that both the eyes
had redness in the temporal region with features of bilateral
conjunctivitis. No other significant history of any allergy was found
on detailed history taking. The patient was referred to ophthalmology
for further management of the condition. She completed 1 week course
of moxifloxacin eyedrops twice a day and a month course of
chloramphenicol eye drops. The patient was symptomatically better
during the treatment. But after the completion of the treatment, the
complaints recurred premenstrually in subsequent menstrual cycles..
The patient was also started on thyroid medication by the
endocrinologist as she was found to be hypothyroid on investigations.
Figure
1. Appearance of the eyes just before menses.
Figure
2. Appearance of the eyes after menses.
Discussion
Cyclical
conjunctivitis is a well known clinical form of PMS though its
occurrence is rare. [3,4] Various allergic reactions related to
menstruation like skin rashes, herpetic eruptions on lip, menstrual
asthma, menstrual coryza and cyclical conjunctivitis have been
reported.1 Some asthmatics can experience attacks
especially premenstrually but that might not always be due to nervous
tension. Oestrogen has also been found to induce such attacks.
Cyclical conjunctivitis or menstrual red eye is usually accompanied
by menstrual coryza. Oestrogen induced swelling of the nasal mucosa
may be responsible for both the above symptoms. The treatment of such
cyclical allergic conditions is usually not very satisfactory as was
seen in our patient.
The
ocular surface is also found to be an oestrogen- dependent unit.[3]
The lacrimal and meibomian glands functions in the humans, to some
extent, are influenced by the sex steroids. This explains the
complaints of dry eye and cyclical conjunctivitis premenstrually. The
subjective symptoms, dryness of eyes, inflammation are significantly
affected by the hormonal variations in the menstrual cycle. The
impairment, especially dryness of eyes, was found to be coinciding
with the oestrogen peak in the follicular phase of the cycle. Also
the chronic inflammation occurring concurrently further strengthens
the evidence of oestrogen’s role in upregulating the
proinflammatory substances in tears. The treatment is usually
symptomatic, lubricant eye drops for dry eye, and antibiotic eye
drops in case of conjunctivitis after ruling out all the other causes
of conjunctivitis. Antihistaminics and steroids can also be used.
References
- Kumar P, Jeffcoate N, Malhotra N. Jeffcoate's principles of gynaecology. New Delhi: Butterworths; 2008, 627-634
- Fritz M, Speroff L. Clinical gynecologic endocrinology and infertility. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011, 581
- Versura P, Fresina M, Campos EC. Ocular surface changes over the menstrual cycle in women with and without dry eye. Gynecological endocrinology. 2007;23(7):385-90.
- Bhaduri BN. Recurrent attacks of phlyctenular conjunctivitis synchronizing with menstruation. Br J Ophthalmol. 1927 Aug; 11(8): 387–388.
Niphadkar
M, Parulekar SV. Menstrual Red Eye. JPGO
2016. Volume 3 No. 2. Available from: http://www.jpgo.org/2016/01/menstrual-red-eye.html