Dry Eye and Menopause: Are My Tears Drying Up?
Does Menopause Cause Dry Eyes?
Some of our patients tell us that their dry eye symptoms seem to be linked to menopause, and this is not unusual. Studies done in the United States found that postmenopausal women have a higher incidence of dry eye disease than men of a similar age.
Decreases in hormones can contribute to changes which cause dry eye symptoms and multiple studies have demonstrated a link between hormones and a susceptibility to dry eye disease.
The tear film is made up of three layers; aqueous (water), lipids (oil) and mucin. Oestrogens and androgens influence the production of all three of these components. Both the lacrimal gland (water producing) and the meibomian glands (oil producing) appear to be affected by menopause. Meibomian gland changes are also associated with a condition, more common in perimenopausal women, called primary acquired nasolacrimal duct obstruction (PANDO) which prevents normal tear drainage.
How is it treated?
Symptoms can sometimes be managed by using simple lubricating drops, available over the counter. If they are not enough, dry eye treatment may be indicated.
Although some studies have found that traditional HRT (oestrogen and progesterone or oestrogen only) can help increase tear production, others have found that it is linked to increased severity of dry eye symptoms. There have not been enough controlled studies to be certain. Androgens generally have more influence on meibomian glands but the benefits of testosterone eye drops are still subject to debate.
Without sufficient evidence for hormone treatment, the most effective treatment for dry eyes in perimenopausal or postmenopausal women depends on the type of dry eye.
Aqueous tear deficiency (ATD), in which the lacrimal gland is not producing enough tears can be treated with punctal occlusion to help retain tears on the surface of the eye. Certain supplements are also believed to help increase tear production.
Milder forms of meibomian gland dysfunction (MGD) can be treated at home with heated eye masks and eyelid massage to melt and expel thickened oils. More severe forms may need treatment options like intense pulsed light (IPL) therapy or low-level light therapy (LLLT) which target inflammation and improve gland health. If there are internal obstructions, meibomian gland probing may be needed to reopen the glands before function can be restored.
Stress can worsen dry eye symptoms as well, so it is important to pay some attention to managing stress levels. Perimenopause and menopause can be a difficult time for many women as changes in circulating hormones can affect mental and physical wellbeing. Engaging in activities which boost your mental wellbeing can also help with your dry eyes.
How do I know what I need?
The first thing is always to have a comprehensive assessment which will determine which component of the tear film is affected and to what degree. A holistic assessment, which takes your overall physical and mental health into account will help identify what else could be contributing to your symptoms. Following your analysis and examination, we can outline an individual treatment plan for you to consider.
Aisha Patel, our Senior Optometrist, has a special interest in the link between dry eyes and menopause and can advise on lifestyle and supplements as well as clinical treatments.
If you believe your dry eye symptoms are related to menopause, book an appointment with Aisha, and find out how we can help.
Give us a call on 03333 444 977.
Sources:
Ablamowicz AF, Nichols JJ, Nichols KK. Association Between Serum Levels of Testosterone and Estradiol With Meibomian Gland Assessments in Postmenopausal Women. Invest Ophthalmol Vis Sci. 2016 Feb;57(2):295-300. doi: 10.1167/iovs.15-18158. PMID: 26830366; PMCID: PMC4736742.
Jin, H and Zhang, H. Changes in the meibomian glands in postmenopausal women with primary acquired nasolacrimal duct obstruction: a prospective study. BMC Ophthalmology (2023) 23:48 https://doi.org/10.1186/s12886-023-02799-3
Peck T, Olsakovsky L, Aggarwal S. Dry Eye Syndrome in Menopause and Perimenopausal Age Group. J Midlife Health. 2017 Apr-Jun;8(2):51-54. doi: 10.4103/jmh.JMH_41_17. PMID: 28706404; PMCID: PMC5496280.
Sullivan, P.D.A., 2004. Tearful relationships? Sex, hormones, the lacrimal gland, and aqueous-deficient dry eye. The ocular surface, 2(2), pp.92-123.
