Role of Menopausal Hormone Therapy on Strabismus, Strabismus Surgery, and Reoperation Rates.

Abstract

To evaluate the association between menopausal hormone therapy (MHT) and strabismus outcomes in menopausal women. Retrospective clinical cohort study. Female patients in Epic Cosmos with a first menopause diagnosis between ages 44 and 60 years from January 1, 2010, to October 31, 2025 were included. MHT exposure was defined as estrogen or combined estrogen-progestin use for ≥90 days after menopause diagnosis; patients with prior MHT use were excluded. Demographic, clinical, and MHT data were extracted. Associations between MHT and strabismus diagnosis, surgery, and reoperation were assessed using time-varying Cox proportional hazards models adjusted for age and year of menopause diagnosis, race, and ethnicity. Strabismus diagnosis, strabismus surgery, and reoperation, excluding congenital, mechanical, neurological, paralytic, and traumatic causes. Among 2,154,255 menopausal patients, 197,576 (9.2%) received MHT and 1,956,679 (90.8%) did not. Mean age at menopause diagnosis was 54.9 (4.1) years, and 67.3% identified as White. MHT use was associated with higher hazards of strabismus diagnosis (HR 1.11, 95% CI 1.02-1.22; P = 0.015) and strabismus surgery (HR 1.76, 95% CI 1.38-2.25; P < 0.001), but not reoperation. MHT was associated with increased risk of strabismus diagnosis and surgery in menopausal women, suggesting a potential relationship between MHT and ocular alignment outcomes.