Dry eyes and menopause demystified

If your eyes are feeling dry, gritty and uncomfortable, you may be suffering from a surprising symptom of perimenopause and menopause

Dry eyes can be a hidden perimenopause or menopause symptom
Hormone changes can affect tear film production
Practical advice on how to treat and manage dry eyes

Dry eye syndrome may not be a well-known symptom of perimenopause and menopause, but it is common – in a Newson Health survey of 5,744 perimenopausal and menopausal women, 50% said they had experienced dry eyes.

Dry eye symptoms include dryness, burning, stinging, a gritty feeling (like sand) in your eye, fluctuating vision and even excessive tearing.

Here, we take a closer look at dry eye syndrome, its link to menopause and how to manage it.

What is dry eye syndrome?

Every time you blink, your eyes release a tear film made up of water, oil and mucous that protects, nourishes and lubricates your eyes.

While tears are mostly made of water, the most common cause of dry eye is not a lack of water in the tears but a diminished or unhealthy oil layer of the tear film. When you blink, oil glands in the eyelids called the meibomian glands secrete oil (meibum) onto the tear film. This oil protects the water layer of the tears, which is underneath.

If the oil layer is unhealthy, or diminished, the water layer will evaporate too quickly. This is called evaporative dry eye. Evaporative dry eye is the most common cause of dry eye – 86% of dry eye has an evaporative component [2].

The oil layer is responsible for maintaining the integrity of the tear film in between blinks. Anything that decreases blinking will make this type of dry eye worse – for example, staring at computer screens/mobile phones/television, long-distance driving and even sleeping. When you’re sleeping at night, your eyes are not blinking so if there is an unhealthy oil layer of your tears, the tear film breaks down overnight which leads to dryness upon waking. Experiencing dry eye after sleeping is a common symptom of evaporative dry eye.

Why might I get dry eyes during perimenopause and menopause?

As you get older, tear production decreases, but hormones also play an important part in tear production. As women age, oestrogen, progesterone and testosterone change.

There is a predictable decline in testosterone during a woman’s life – testosterone peaks in a woman’s 20s but declines by 50% by her 40s. There is then a continued 25% decrease in testosterone in a woman’s 50s and another 25% reduction in her 60s [3]. Testosterone is the most abundant sex hormone in a woman’s body and is very important for the health of the oil glands (meibomian glands) in the eyelids. Testosterone promotes the meibomian glands to make enough oil, make healthy oil and keeps the glands healthy and functional [4,5]. When the meibomian glands are unhealthy, this is called meibomian gland dysfunction. Meibomian gland dysfunction is the most common cause of evaporative dry eye [6].

What else can cause dry eyes?

Other factors that can contribute to dry eyes include:

being over the age of 50
wearing contact lenses
looking at computer screens for a long time without a break
spending time in air conditioned or heated environments
windy, cold or dusty conditions
smoking or drinking alcohol, both of which can dehydrate your body
certain medicines, for example antidepressants, antihistamines, blood pressure medicines, glaucoma eye drops, anti-androgen medications
health conditions, such as autoimmune diseases like Sjögren’s syndrome or lupus, diabetes, thyroid disease

How can I treat and protect against dry eyes?

Use an eye mask

A warm compress or eye mask applied to closed eyelids can help to melt the oil in the meibomian glands into the tear film. The melting point of the meibum is 42-44°C so use a warm (not hot) compress on the eyes for 8-10 minutes.

Keep your eyelids clean

Carefully cleaning your eyelids can help to remove debris and bacteria – the NHS has a good guide here.

Eye drops

Using preservative-free dry eye drops can ease your symptoms. Most eye drops are water supplements but there are over-the-counter eye drops with water and oil supplements that are better for evaporative dry eyes.

Try to limit screen time

When you are using a screen, you blink less, which can make your eyes drier. Try using the 20-20-20 rule: for every 20 minutes of screen time, look at least 20 feet away for 20 seconds.

Protect your eyes from the elements

Cold weather and wind can cause tears to evaporate too quickly and exacerbate dry eyes. Wraparound sunglasses can help protect your eyes, particularly if out running or cycling. If you wear contact lenses, speak to your optician about ones that will help to keep your eyes more moist, and keep a pair of glasses to give yourself some contact lens-free days.

Be aware of your triggers

Do contact lenses, smoky atmospheres or pollen make your eyes itch? Keep a record of your triggers and try to avoid them where practically possible. The balance app can help you record the type, severity and duration of your symptoms.

Check humidity

A humidifier in your home can help to keep your eyes moist, so your tears won’t evaporate as quickly. Humidifiers can be very beneficial overnight and in places where you might be looking at electronic devices so not blinking as often.

Consider your diet

Omega-3 fatty acids and vitamin A can both encourage healthy tear production. Omega 3s can be found in fatty fish, oysters, walnuts, flaxseed and chia seeds. Vitamin A is found in liver, sweet potatoes, butternut squash, carrots and dark green leafy vegetables. Both can also be taken as over-the-counter supplements.

It’s important to see an optician or GP if you still have dry eyes after trying home treatments for a few weeks, your symptoms are worsening or you notice any change to your eyes or eyelids.

With contributions from Lauren Gormley, O.D. Dr Gormley specialises in Ocular Surface Disease at the Wilmer Eye Institute, Johns Hopkins University.

References

Newson Health (2022), ‘Experiences of Perimenopause and Menopause’
Lemp M.A., Crews L.A., Bron A.J., Foulks G.N., Sullivan B.D. (2012), ‘Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study’, Cornea. 31(5) pp472-8. doi: 10.1097/ICO.0b013e318225415a
Brzozowska M., Lewiński A. (2020), ‘Changes of androgens levels in menopausal women’, Prz Menopauzalny, 19(4) pp151-154. doi: 10.5114/pm.2020.101941
Sullivan D.A., Jensen R.V., Suzuki T., Richards S.M. (2009), ‘Do sex steroids exert sex-specific and/or opposite effects on gene expression in lacrimal and meibomian glands?’ Mol Vis. 10(15) pp1553-72. PMID: 19693291; PMCID: PMC2728565.5.
Nichols K.K., Foulks G.N., Bron A.J., Glasgow B.J., Dogru M., Tsubota K., Lemp M.A., Sullivan D.A. (2011), ‘The international workshop on meibomian gland dysfunction: executive summary’, Invest Ophthalmol Vis Sci, 52(4) pp1922-9. doi: 10.1167/iovs.10-6997a
Chan T.C.Y., Chow S.S.W., Wan K.H.N., Yuen H.K.L. (2019), ‘Update on the association between dry eye disease and meibomian gland dysfunction’, Hong Kong Med J, 25(1) pp38-47. doi: 10.12809/hkmj187331