Kaštelan Snježana, Hat Koraljka, Tomić Zora, Matejić Tomislav, Gotovac Nikola
Department of Ophthalmology, Clinical Hospital Dubrava, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia.
Department of Maxillofacial Surgery, Clinical Hospital Dubrava, University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia.
Int J Mol Sci. 2025 Apr 18;26(8):3833. doi: 10.3390/ijms26083833.
Sexual dimorphism significantly impacts the lacrimal gland's structure, function, and ageing processes, playing an important role in dry eye disease (DED) pathophysiology. This multifactorial disorder, characterised by tear film instability, inflammation, and visual impairment, disproportionately affects women, especially after menopause. It highlights the interplay between sex steroid hormones, lacrimal gland function, and environmental factors. Systemic and local androgens are vital for maintaining lacrimal gland health and tear production, while the role of oestrogens remains less clear. Evidence suggests dose and context-dependent effects on inflammation and glandular function. Histopathological and molecular studies reveal significant sex differences in the lacrimal gland, with women exhibiting more pronounced age-related degenerative changes, including fibrosis and acinar atrophy, contributing to their increased susceptibility to DED. Despite these findings, the underlying mechanisms connecting sex steroid hormones, receptor expression, and local tissue regulation to these disparities remain poorly understood, highlighting the need for further research. This review synthesises the current knowledge of sex-specific differences in the lacrimal gland, emphasising the importance of integrating systemic and local biomarkers, histological data, and molecular insights into personalised therapeutic strategies. By tailoring treatments to patients' unique hormonal and molecular profiles, personalised medicine has the potential to transform DED management, addressing unmet clinical needs and improving outcomes.
性别差异显著影响泪腺的结构、功能和衰老过程，在干眼症（DED）的病理生理学中发挥着重要作用。这种多因素疾病的特征是泪膜不稳定、炎症和视力损害，对女性的影响尤为严重，尤其是在绝经后。它突出了性类固醇激素、泪腺功能和环境因素之间的相互作用。全身和局部雄激素对维持泪腺健康和泪液分泌至关重要，而雌激素的作用尚不清楚。有证据表明，雌激素对炎症和腺体功能的影响取决于剂量和具体情况。组织病理学和分子研究揭示了泪腺存在显著的性别差异，女性表现出更明显的与年龄相关的退行性变化，包括纤维化和腺泡萎缩，这导致她们更容易患干眼症。尽管有这些发现，但将性类固醇激素、受体表达和局部组织调节与这些差异联系起来的潜在机制仍知之甚少，这凸显了进一步研究的必要性。本综述综合了目前关于泪腺性别特异性差异的知识，强调了将全身和局部生物标志物、组织学数据和分子见解整合到个性化治疗策略中的重要性。通过根据患者独特的激素和分子特征量身定制治疗方案，个性化医学有可能改变干眼症的管理方式，满足未满足的临床需求并改善治疗效果。
