Dry Eyes and Menopause: Yep, Apparently That’s a Thing Too

Written By Courtney Wagner

Dry eye. Ugh. One of the many gifts that menopause keeps on giving.

One day, my eyes were fine. The next, they were itchy and burning, I was blinking every two seconds, and no amount of eye drops seemed to give me much relief.

I finally went to my eye doctor, was given some drops and a few exercises and was basically sent packing with a sympathetic, “Good luck.”

Great.

We hear a lot about the more common symptoms of perimenopause and menopause, like hot flashes, night sweats, sleep issues, brain fog, weight changes, vaginal dryness. But dry eyes? That one doesn't seem to make the headlines.

And yet, there is actually quite a bit of science connecting hormones and eye health.

A major scientific review from the Tear Film & Ocular Surface Society (TFOS) concluded that dry eye disease occurs more frequently in women than men and that sex hormones play an important role in the tissues that regulate the surface of our eyes.

So if your eyes suddenly feel like they’ve aged 20 years over night, there may actually be a reason.

Let’s talk about why it happens, what hormones have to do with it and, most importantly, what you can do about it.

First, what exactly is dry eye?

Dry eye is more complicated than simply “my eyes need more moisture.”

Our tear film contains water, oil and mucus, and all three work together to keep the surface of the eye comfortable and protected.

Along the edges of our eyelids are tiny glands called meibomian glands. They produce an oily substance called meibum, which forms the outer layer of our tears and helps keep them from evaporating too quickly.

If those glands aren't working properly, your tears can evaporate too quickly.

The result can be burning, stinging, itching, redness, blurry vision, sensitivity to light, a gritty feeling or even difficulty wearing contacts. I can confirm all of these nasty results to be true.

And here's a strange one: watery eyes can actually be a symptom of dry eye.

When the surface of the eye becomes irritated, your eyes may respond by producing more watery tears. But those tears don't necessarily contain enough of the oily component needed to keep them from evaporating.

The American Academy of Ophthalmology has a good overview of how this works and the different types of dry eye.

Because apparently even dry eyes can be wet. Make that make sense.

So what does menopause have to do with it?

This is where things get interesting.

Sex hormones don't just affect our reproductive organs. Hormone receptors are found in tissues throughout the body-including the structures involved in keeping our eyes healthy.

A review specifically examining dry eye in postmenopausal women found that reproductive hormones appear to play an important role in the development of dry eye disease. Interestingly, researchers found that lower androgen levels were more consistently associated with dry eye than simply having “low estrogen.”

That distinction matters.

We have a tendency to blame every midlife symptom on declining estrogen, but our hormonal system is much more complicated than that.

It's not just about estrogen

Androgens, including testosterone, appear to play a particularly important role in the health of the meibomian glands.

The large TFOS DEWS II Sex, Gender and Hormones Report found that androgen deficiency is associated with both aqueous-deficient and evaporative dry eye. Researchers also concluded that androgens are important regulators of the meibomian and lacrimal glands.

Another review of sex hormones and dry eye reached a similar conclusion: androgens affect the structure and function of both the meibomian and lacrimal glands, while the effects of estrogen and progesterone appear to be more complicated and, in some studies, contradictory. Read the PubMed review.

Translation?

Hormones absolutely appear to matter. We just don't completely understand the relationship yet.

Which is an important distinction because I don't want this to become another internet rabbit hole where we're told that every symptom means our estrogen is “too low” or “out of balance.”

The science isn't that simple.

Is dry eye actually more common around menopause?

There is good evidence that dry eye becomes increasingly common as we age and that women are disproportionately affected.

A review focused specifically on women in the perimenopausal and menopausal age group found that changes in sex hormones may influence all three major components of the tear film—the aqueous (watery) layer, lipid (oil) layer and mucin layer. Read the review on PubMed.

However, there is an important nuance here.

Age itself is also a risk factor for dry eye. The TFOS scientific review points out that dry eye prevalence gradually increases with age in both women and men, which makes it difficult to separate the effects of menopause from the effects of aging itself.

In other words, menopause is likely part of the picture, but it isn't necessarily the whole picture.

Will hormone therapy fix dry eye?

Naturally, this was one of my first questions.

Unfortunately, this is where the research gets even murkier.

If hormonal changes contribute to dry eye, it seems logical that replacing estrogen would improve it.

But that hasn't consistently happened in studies.

A review published in the journal Menopause found that menopausal hormone therapy with estrogen or estrogen plus a progestogen has shown limited benefit for dry eye and, in some studies, was associated with worsening measures of meibomian gland function or tear-film stability.

On the other hand, a meta-analysis of seven randomized controlled trials involving 358 women found improvement in one measure of tear production after sex-hormone treatment, although results varied considerably among the studies.

So where does that leave us?

Basically here:

Hormone therapy is not currently a straightforward treatment for dry eye.

And dry eye alone certainly isn't a reason to start, stop or change your hormone therapy without talking to your healthcare provider.

What can you actually do about it?

This is where I've learned that managing dry eye often requires more than grabbing whatever bottle of eye drops happens to be on sale at CVS.

Try preservative-free artificial tears

Artificial tears can help replace some of the moisture your eyes are missing.

If you're using drops frequently, the American Academy of Ophthalmology recommends preservative-free artificial tears when you're using them more than six times per day, because preservatives themselves can begin to irritate the eyes with frequent use. AAO dry eye treatment recommendations.

Use a warm compress

Warm compresses can help soften the oils produced by the meibomian glands and encourage them to flow more easily.

For me, this has become one of those glamorous midlife rituals I never knew I'd need.

Pay attention to screens

When we're staring at computers and phones, like I’m doing now writing this, we tend to blink less. Less blinking means the tear film isn't being redistributed across the eye as frequently, which can contribute to dryness.

Take breaks, look away from your screen and make a point of blinking.

Yes, we've officially reached the stage of life where I'm reminding you to blink.

Look at your environment

Fans, air conditioning, heating, wind and dry indoor air can all make symptoms worse.

A humidifier can help if your home is particularly dry, and sunglasses can help big time.

Pay attention to your makeup

This was a big one for me.

I started noticing that my symptoms were noticeably worse on days when I wore more eye makeup.

Mascara, eyeliner, eye shadow, makeup remover and products applied close to the lash line can all become more noticeable when your eyes are already irritated.

That doesn't mean you have to throw away your makeup bag.

Just pay attention.

If your eyes are miserable by 3 p.m. every day you wear a particular mascara but fine when you don't, that's useful information.

What if the basics aren't working?

If you've tried artificial tears, warm compresses and environmental changes and you're still miserable, don't assume you just have to live with it.

Dry eye disease has different causes, which means treatment should ideally address why your eyes are dry in the first place.

An ophthalmologist can evaluate your tear production, tear-film quality and meibomian glands. Depending on what they find, treatment may include prescription anti-inflammatory drops, medications that help increase tear production, punctal plugs that slow tear drainage or treatments specifically targeting the meibomian glands.

The American Academy of Ophthalmology provides a good overview of these treatment options. See dry eye treatments from the AAO.

Another midlife symptom worth talking about

One thing I've learned over and over again is that menopause can show up in places we never expected.

Our eyes. Our joints. Our skin. Our mouth. Our sleep. Our muscles. Our mood.

And not every symptom that appears during midlife is automatically caused by menopause.

But understanding that there may be a connection gives us another piece of information to bring to our healthcare providers instead of assuming that every weird new thing happening in our 40s and 50s is completely unrelated.

I'm still figuring out my own dry-eye situation. Some days are better than others, and I'm definitely more aware now of what makes it worse.

But I also think this is exactly why we need to keep talking about the less obvious symptoms of menopause.

Because if I'm walking around blinking 400 times a minute wondering what on earth happened to my eyes, chances are I'm not the only one.

A few resources if you want to nerd out with me:

This article is for educational purposes only and isn't intended to diagnose or treat a medical condition. Persistent or severe eye symptoms, eye pain or changes in vision should be evaluated by a qualified eye-care professional.

Courtney Wagner https://www.courtneywagnerwellness.com
Previous

Perimenopause May Start Earlier Than We Thought. Here's What New Research Reveals.
Next

Why Your Healthy Habits Aren’t Sticking (And the Simple Shift That Changes Everything)