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ARTICLES
Year : 1972  |  Volume : 20  |  Issue : 4  |  Page : 145-148

Variation in intraocular pressure during the menstrual cycle


Department of Ophthalmology, Medical College, Agra, India

Correspondence Address:
Veena Misra
Department of Ophthalmology, Medical College, Agra
India
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Source of Support: None, Conflict of Interest: None


PMID: 4677634

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How to cite this article:
Misra V, Awasthi P, Sarkar B. Variation in intraocular pressure during the menstrual cycle. Indian J Ophthalmol 1972;20:145-8

How to cite this URL:
Misra V, Awasthi P, Sarkar B. Variation in intraocular pressure during the menstrual cycle. Indian J Ophthalmol [serial online] 1972 [cited 2021 Mar 4];20:145-8. Available from: https://www.ijo.in/text.asp?1972/20/4/145/34635

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The problem of glaucoma in recent years has assumed such wide proportions as to call for a drastic reorientation in our approach. One aspect of the subject, namely the aetiology of glaucoma still remains shrouded in a veil of mystery.

The period of menstruation is frequently accompanied by eye mani­festations of a disturbing nature in women who appear to be normal in all other respects. Evidence has been accumulating for some time now which shows that during the menstrual cycle, there occur changes in intra­ocular pressure. Many points of similarity have also been brought out between closed angle glaucoma and premenstrual migraine. It was with a view to observe the changes in intra­ocular pressure occurring during the various phases of menstrual cycle that the present study was undertaken.


  Material and Methods Top


The cases selected comprised of medical students, nurses, patients attending the gynaecology department and some of the cases coming to the glaucoma clinics. A total of 96 cases were selected which were subdivided into 4 groups.

A 42 had normal menstruation.

B 32 had premenstrual tension. syndrome.

C 15 had menopause and

D 7 had ammenorrhoea.

The age of normally menstruating females, patients with premenstrual tension and patients with amenorrhoea ranged between 18 to 40 years. The menopausal females were between 45-60 years of age.

These cases were submitted for the following examinations.

  1. Estimation of intraocular pres­sure by Schiotz tonometer in mm Hg.
  2. Estimation of blood pressure by sphygmomanometer in mm Hg.
  3. Weight estimation in kilograms.


The menstruating females were submitted to these examinations, three times during the course of the men­strual cycle a premenstrual reading taken 4 days before the expected date of bleeding, a menstrual reading during the active bleeding phase and a post menstrual reading taken 4 days after the cessation of bleeding.

The patients having menopause and amenorrhoea were submitted to these three examinations three times a month, the time of record being 10 days apart.

A. Normally Menstruating

The average intraocular tension in 42 cases were 18 mm in postmens­trual period, rising to 20 mm in pre­menstrual period and subsequently falling to 18.4 mm in the menstrual period. Cyclical variation in intra­ocular tension with a rise during the premenstrual phase of the cycle was observed in 7 cases only out of 42.

The average changes in the blood pressure and body weight are indicated in [Table - 1].

B. Cases of Premenstrual tension syndrome

In the cases showing evidence of premenstrual tension syndrome the average intraocular tension of 32 cases was 17 mm in the post menstrual phase subsequently rising to 24.5 mm in the premenstrual phase and in the menstrual phase averaging 18 mm.

A cyclical variation in intraocular tension was observed in 20 of these cases. 16 showing a premenstrual rise and 4 showing a rise in the menstrual phase.

III Menopausal

In the postmenopausal cases observed the average intraocular tension of 15 cases was found to be almost 20 mm of Hg. in the three readings taken at 10 days intervals. No definite cyclical variation could be observed. The blood pressure and body weight also showed no variation.

IV Amenorrhoea

The average intraocular tension in these cases recorded near 18 mm in the three readings taken. Thus no cyclical variation could be seen. The body weight and blood pressure also showed no alteration.


  Discussion Top


A large number of hormones are known to affect the intraocular tension. Of these, the female sex hormones are the predominent ones to cause variations in intraocular tension.

DALTON, in 1966 has mentioned a rise of intraocular tension in the premenstrual and menstrual phases of the cycle.

From our observations, it is clear that in females, the intraocular tension shows a slight but definite variation during the course of the menstrual cycle. [Table - 1][Table - 2]

Group I

In the normal menstruating women observed in our series 83.3% of cases showed no cyclical variation in intraocular tension, 16.7% cases however showed a definite rise in intraocular tension during the pre­menstrual phases the pressure settling down to normal in the post menstrual phase (Graph 1).

Group II

Of the cases showing definite symptoms of premenstrual tension, 63% showed definite variation in intraocular tension during the various phases of menstrual cycle. In 50% of the cases, the tension was found to rise only in the premenstrual phase while in 13% a paramenstrual rise i.e. in both the premenstrual and menstrual phases was observed. 37% cases showed no cyclical variation. The average rise was higher than the variations in the case of normal women.

GROUP III & IV

Menopausal female and patients of ammenorrhoea showed no signi­ficant cycle variation in introcular tension.

EXPLANATION

The blood level of oestrogen in the premenstrual phase of cycle is much higher as compared to progestrone, the latter being present in negligible amounts. With the onset of bleeding sharp fall in oestrogen accompanied by a rise in the level of progestrone occurs. (Graph 2) According to our observations in the majority of cases showing variation in intraocular tension, a premenstrual rise was observed. With withdrawal of oestrogen, the tension also comes back to normal.

The brunt of the responsibility for causing a rise in intraocular tension falls on oestrogen.

Physiologically oestrogen is a water retaining hormone, an action mani­fested by increase of blood volume, rise, of blood pressure and increased body weight. Water retention could be said to be one of the important factors in raising intraocular tension.

A hyperexcitable, sympathetico­tonic type of personality is usually found in cases of closed angle glaucoma as well as in premenstrual tension syndrome: A disturbance in hypo­thalamic control could thus be postulated as the aetiological factor in both.

In patients with premenstrual tension syndrome, gynaecologists have managed to isolate a chemical substance, supposedly released as a product of tissue injury. One of these has vasospastic properties, which could account for the rise in intra­ocular pressure by raising the blood pressure as well as water logging of urea.

It has been reported that this sub­stance stimulates the pituitary secre­tions of thyroid, gonads, adrenals and breasts. Assuming that pituitary is hyperactive it is our assumption that secretion of A.D.H. and growth hormone could also be anticipated which can explain the raised intra­ocular tension, raised blood pressure and gain in weight during pre­menstrual and menstrual phase.


    Figures

  [Figure - 1], [Figure - 2]
 
 
    Tables

  [Table - 1], [Table - 2]



 

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