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Year : 1974  |  Volume : 22  |  Issue : 1  |  Page : 21-24

Facility of outflow during the normal menstrual cycle

Institute of Ophthalmology, Gandhi Eye Hospital, Aligarh, India

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R L Vaid
Institute of Ophthalmology, Gandhi Eye Hospital, Aligarh
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Source of Support: None, Conflict of Interest: None

PMID: 4448530

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How to cite this article:
Vaid R L, Saiduzzafar H, Ahuja L. Facility of outflow during the normal menstrual cycle. Indian J Ophthalmol 1974;22:21-4

How to cite this URL:
Vaid R L, Saiduzzafar H, Ahuja L. Facility of outflow during the normal menstrual cycle. Indian J Ophthalmol [serial online] 1974 [cited 2020 Jun 1];22:21-4. Available from: http://www.ijo.in/text.asp?1974/22/1/21/31385

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Table 1

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Table 1

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Perkins [8] and Patterson [6] have reported that the incidence of open angle glaucoma, before the age of 50 years, is greater in males than in females, but beyond this age the dif­ference becomes much less. This indicates that a protective mechanism which is respon­sible for the lower incidence of glaucoma in premenopausal period becomes defunct with the onset of menopause, so that both the sexes are equally affected. Stray reports correlat­ing the hormonal variations during the normal menstrual cycle, with the intraocular pressure and incidence of glaucoma, started appearing as early as 1923, when Salvatis noted an increase in intraocular pressure du­ring menstruation. Lagrange [4] and Weinstein [11] observed that acute attacks of angle closure glaucoma tended to occur preferentially dur­ing menstruation and Dalton [2] also reported a definite time relationship between menstrua­tion and ocular symptoms. Shahan [10] reported a small but definite cyclic variation in the facility of outflow and in intraocular pressure in some females during menstrual cycle. Becker [1] reported an increase in the facility of outflow in the progestational phase of the menstrual cycle. Patterson and Miller [6] after tonographic studies reported that facility of outflow varies in the different phases of mens­trual cycle. In view of the observations made by various workers it appears that the hor­monal variation occuring during the normal menstrual cycle have some influence on the outflow value.

The present tonographic study has been carried out with the aim to assess the effect, if any, of variation in the hormonal levels (mstrogen and progesterone) occuring during the normal regular menstrual cycle on the facility of outflow.

  Material and Methods Top

60 women, included in this study, were selected from the patients attending the Gandhi Eye Hospital for refractive problems. These were thoroughly ex­amined to rule out the possibility of glaucoma and any other concurrent ocular disease. Detailed gynaeco­logical history was taken and the selected cases had normal and regular menstrual cycles. The cases with menstrual irregularities were not included in this study.

These cases were divided into three subgroups on the basis of age as shown in [Table - 1].

Applanation tonometry and tonography was per­formed on 120 eyes of 60 women following the standard technique using Schwazer's self recording tonographic equipment. Four minutes tonograms were obtained and facility of outflow was calculated using Friedenwald's (1955) nomogram. Tonography was performed on the 1st, 7th, 14th, 21st and 25th day of the menstrual cycle as these days coincided with known definite variations in the level of xstrogen and pro­gesterone during the regular normal menstrual cycle, [Figure - 1]

  Results and Discussion Top

Excretion curve studies of oestrogen con­tent show two well defined peaks during the normal menstrual cycle. Oestrogen is present in small quantities at the start of the cycle, but reaches its peak two days prior to the ovulation, followed by a sudden drop. The second peak, usually lower than the first occurs in the luteal phase, followed, by a decrease in its contents till, three to four day's before the menstruation when the amount is reduced to minimal quantity. The progesterone, on the other hand is present in very small quantity during the first half of the menstrual cycle, but there is rapid increase in its amount after ovulation till two to three day's before onset of menstrual flow when its amount decreases rapidly. It is clear that at the ovulation i.e. round about 14th day and 2-3 days before menstrual flow i.e. about 25th day of the menstrual cycle, the oestrogen and progesterone are present in minimal amount, while on 1st, 7th and 21st day one or both of these are present in sufficient quantities.

The facility of outflow varies over a wide range but the average values when compared and analysed, show a definite trend especially in relationship to the hormonal level variation during the normal menstrual cycle. The dif­ference in the average value which is visible in the group as a whole is also present in the subgroups, without significant change. The mean values along with the standard deviation are shown in [Table - 2], and the dis­tribution of the average values in the main group and sub-groups is shown in rig. 11. The average value for the facility of outflow are nearly the same, for the 1st, 7th and 21st day, but the same values are much less for the 14th and 25th day of the normal menstrual cycle. Apparently it appears that facility of outflow is decreased with the marked decrease in the level of both hormones i.e. on the 14th and 25th day. On 1st, 7th and 21st day when one or both hormones are present in sufficient quantities the facility of outflow is also relatively much higher, indicating that these hormones influence the outflow mechanism in some ill understood way. The difference in the highest and lowest values were subjected to statistical analysis and on application of t. test [Table - 3] it was found that these dif­ferences were statistically significant, not only in the main group, but also in the sub-groups. We conclude from statistical analysis of our data that facility of outflow is significantly affected by the hormonal variation occuring during the normal menstrual cycle. The absence of these hormones, by decreasing the facility of outflow, may contribute to making females prone to open angle glaucoma after meno­pause, which may explain the observations by Perkins [8] and Patterson [6] . Similarly the utility of progesterone in control of glaucoma as reported by Obal [5] and Posthumos [7] can be explained in terms of this observation. It also confirms the observations of Shahan [10] , Becker [1] and Patterson [6] . The mode of action of these hormones, however, is not known.

  Summary Top

Tonographic studies were made on 120 eyes of 60 normal women with regular mens­trual cycle on Ist, 7th, 14th, 21st and 25th day of menstrual cycle.

The facility of outflow was calculated in each case. The results obtained were statisti­cally analysed.

The facility of outflow was found to be significantly decreased, with the decrease in the oestrogen and progesterone level occuring during the normal menstrual cycle.

  References Top

Becker, B. and Friedenwald, J.S., 1953, A.M.A. Arch. Ophthal., 50, 557.  Back to cited text no. 1
Dalton, 1967, Brit. J. Ophthal., 51, 692.  Back to cited text no. 2
Jhonstone, R. W., 1961, A text book of Midwifery, 10th ed., 50, Adam. & Charles Black, London.  Back to cited text no. 3
Lagrange, 1925, Brit. J. Ophthal., 9, 398.  Back to cited text no. 4
Obal, A., 1950, Klin. Montasble & Angenhcilk, 117, 201.  Back to cited text no. 5
Patterson, G.D. and Miller, S.J.H., 1963, Brit. J. Ophthal., 47, 129.  Back to cited text no. 6
Pcsthurnos, R.G., 1952, Ophthalmologica, 124, 17.  Back to cited text no. 7
Perkins and Jay, 1928, Trans. Ophthal. Soc., U.K., 80, 153.  Back to cited text no. 8
Salvati, M., 1928, Ann. Occ., 160, 568.  Back to cited text no. 9
Shahan, P.T., Paper read before the association for research in ophthalmology. Inc., Chicago, June, 1952. Quoted by Becker (1).  Back to cited text no. 10
Weinstein, 1935, A.M.A. Arch. Ophthal., 13, 181.  Back to cited text no. 11


  [Figure - 1], [Figure - 2]

  [Table - 1], [Table - 2], [Table - 3]


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