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

PURPOSE: To evaluate the association between menopausal hormone therapy (MHT) and strabismus outcomes in menopausal women.

DESIGN

Retrospective clinical cohort study.

PARTICIPANTS

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.

METHODS

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.

MAIN OUTCOME MEASURES: Strabismus diagnosis, strabismus surgery, and reoperation, excluding congenital, mechanical, neurological, paralytic, and traumatic causes.

RESULTS

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.

CONCLUSION

MHT was associated with increased risk of strabismus diagnosis and surgery in menopausal women, suggesting a potential relationship between MHT and ocular alignment outcomes.