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Menopause and Dry Eyes

Could changes in hormones be affecting your Ocular health and comfort? Hormones have more to do with Dry Eye than you may have realized.

I specialize in dry eye, so I see and treat patients of every age and gender. But it’s interesting to note that dry eye is particularly common in patients who are experiencing some kind of hormonal shift like pregnancy, birth control changes or, of course, menopause and perimenopause.

People often don’t realize how much hormones can impact their eye health, so they’re not ready for new symptoms to develop. It can be jarring and even a little scary to suddenly feel like your eyes are irritated and dry all the time.

Today I’d like to chat about how hormones can trigger dry eye disease, and what you can do about it. Read on to learn at your own pace, or you can hear me talk about it here on my YouTube channel.

Before Hormones & Dry Eyes: A Quick Primer on Tear Film

Before we get into the impact of sex hormones on dry eye, we need to understand a little bit about tear chemistry. Your tears contain a thin layer of oil (called the tear film) which floats on the surface of the tears to prevent them from evaporating off of your eye. If the tear film is incomplete or unstable, your tears can evaporate, which prevents them from hydrating, lubricating, and cleaning your eyes properly.

The oil that makes up the lipid layer of your tear film is called meibum. Meibum is produced and secreted by the meibomian glands, which are located in the margins of your eyelid (sometimes called the waterline).

How Do Sex Hormones Influence Dry Eyes?

We all have sex hormones: estrogen, which is commonly associated with more feminine traits, and androgen (mostly testosterone) which is commonly associated with more masculine traits. Both of these hormones impact the way our bodies create tears and the quality of the tear film.

The meibomian gland contains sex hormone receptors; in essence, it responds to your body’s androgen and estrogen levels. When androgens bind to the receptors, the glands create and secrete more meibum. On the other hand, when estrogen binds to the receptors, the glands create and secrete less meibum.

More meibum means your tears work well, while less meibum means tears work poorly.

If you’re a little bit confused, don’t worry, scientists are too. Researchers know that sex hormones impact meibomian production, but they don’t quite know why just yet.

What Else Can Cause Dry Eyes?

Dry eye is a multifactorial condition, which means it can develop as the result of your environment or biological factors. Some external or environmental factors could include:

  • Pollution

  • Dry climate

  • Dust

  • Wind

  • Hot or cold weather

  • Lots of pollen in the air

Some internal or biological factors could include:

  • Gender

  • Hormone levels

  • Connective tissue disease

  • Hepatitis C

  • Ethnicity

  • Diabetes

How to Combat Dry Eye Symptoms

First of all, I highly recommend finding a doctor who specializes in dry eye. Any optometrist can prescribe medicated drops or recommend artificial tears, but an optometrist that specializes in dry eye probably dedicates more time and energy into researching new treatments and therapies. There’s also a good chance that they’re equipped to analyze your tears more closely and find out the root cause behind your symptoms, which allows them to prescribe the right treatment (or combination of treatments) for your unique case.


Is it obvious? Yes. Does it work? It certainly helps. You need to stay very well hydrated to keep your mucous membranes moist and lubricated. If you’re in menopause, you’ve probably noticed that it’s not just your eyes that feel dry; there’s usually mouth dryness, vaginal dryness, and eye dryness all at once. Water can help all of that.

Watch What You Eat!

It’s best to keep anything inflammatory out of your diet as much as possible. Caffeine and sugar are pretty common culprits. But it’s also possible that other foods, ingredients, or additives give you an inflammatory response. Gluten is one example of a substance that may not affect everyone, but if your body is intolerant or allergic to it, it could definitely impact your eye health.

You should also consider adding omega-3 supplements to your diet. Omega-3s are a natural anti-inflammatory, which makes them great for your eyes and your overall health.

I do have one important note about omega-3 supplements though; make sure you’re using a pharmaceutical grade, high-quality fish oil so your body can get the most out of it. Nordic Naturals are my favorite, but there are plenty of other options out there. Just make sure to check the label for high levels of EPA-DHA in the supplement and that it’s triglyceride form.

Use the 20-20-20 Rule!

We blink far less when using laptops, smartphones, and tablets, which allows our eyes to dry out. To give your eyes a quick rest, take 20-second breaks to look at something 20 feet away every 20 minutes.

Switch to Non-Toxic Makeup!

Most eye makeup can have a really negative impact on your eyes. Personally, Eyes Are the Story; they’re a beauty brand that focuses on creating eye-safe products. Their cosmetics are designed specifically for folks suffering from dry eye.

I wear it myself and have ever since I did my unboxing video on my channel.

What About Hormone Replacement Therapy?

In some ways, the medical community is divided on how to help people with dry eye as they go through menopause. Some research says hormone replacement therapy is a good way to fix hormone-related dry eye. On the other hand, some research says HRT could actually make symptoms worse.

Based on the research I’ve done, I think it depends on the type of hormones you take when undergoing HRT: conventional hormones or bioidentical hormones. You will have to talk to your optometrist, your family doctor, your gynecologist, and/or your endocrinologist to decide which type of hormone replacement therapy is right for you.

How Else Can Hormones Affect Eye Health?

Here’s a quick list of some of the other ways hormones can impact your eye health. For a little more detail on these, I’d recommend checking out the video I made on this topic.

  • Change of corneal shape, changing your prescription & ability to wear contacts

  • Cataract development, which impairs your vision, and eventually requires surgery

  • Glaucoma, which damages the optic nerve and requires ongoing management

  • Macular degeneration, which damages central vision and requires ongoing management

I know, this list isn’t the best news. But don’t despair! If you go for regular eye exams, your doctor should be able to track lots of these changes and help you find a solution for clearer, healthier vision.

Hormonal changes are mostly inevitable. But major eye health problems don’t have to be. Make sure you see your GP and your optometrist regularly to keep your eyes strong and your hormones balanced.

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