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Does Menopause Cause Dry Eye?

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Menopause comes with many changes. Hot flashes are a well-known side-effect of menopausal changes to your hormone levels, but one that’s not as well known is dry eye syndrome. As we age, male or female, tear production decreases, meaning the natural level of your tears goes down.

Dry eye therapy can help in various ways, but prevention goes a long way. But some of our patients have heard menopausal women develop dry eye around the same time. In this article, we’ll discuss the link and whether there’s a cause in it.

Cartoon of a woman with flames around her having a hot flash

Dry Eye & Your Cornea

Your cornea is a transparent dome sitting on the outside layer of your eye. It plays a large role in bending images composed of visible light onto your retina, a membrane of detection cells for a light at the back of your eye.

The cornea needs significant moisture to keep it healthy and supple. It takes water and nutrients from the natural level of tears in your eyes, called the tear film. If it doesn’t get it, it can cloud over or even deform in severe cases of dry eyes, which can harshly disrupt your vision.

But before it advances that far, you’ll likely experience uncomfortable symptoms like itchiness, redness, and irritation in your eyes.

Your Tear Film

This natural level of tears, which some aren’t aware of, is called the tear film. Your tear film is made of 3 layers:

  • Mucin Layer: this layer of mucous comes from your conjunctiva, even your cornea, and it acts as a base for the water layer.
  • Aqueous layer: this layer of water is made up of tears. It’s produced from the lacrimal gland, and it provides the hydration and oxygen your eyes need, especially the cornea.
  • Lipid Layer: this layer of fats and oil coats the aqueous layer, to prevent typical water evaporation rates. It’s produced in the meibomian glands, tiny shafts in your eyelids.

Evaporative Dry Eyes

Evaporative dry eye (EDE) comes when tears evaporate too quickly. It’s often due to blockage in the oil glands, impacting the lipid layer. Some causes of EDE include:

  • Skin conditions on or near the eye
  •  Excess contact lens use
  • Vitamin A deficiency
  • Toxins
  • Healing from physical trauma to the eye

It can also set in as a side effect of certain medications.

Aqueous Tear-Deficient Dry Eyes

Aqueous tear-deficient dry eyes can occur when your lacrimal glands fail to produce enough tears. The water needed to hydrate and oxygenate your cornea just isn’t there. The causes can vary wildly, but they can include:

Hormonal Changes & Your Tear Film

Your tear film can easily be imbalanced because your lacrimal and meibomian glands are sensitive to your hormone levels. Dry eye usually boils down to that imbalance more than anything. Although the different dry eye types come from other causes, the experience is usually the same. Your cornea is generally at the most risk.

Natural Changes to Your Hormones

Menopause is a natural rite of passage for women. And it can result in a vastly different hormonal balance than before. The female body produces less progesterone and estrogen after menopause.

Androgen is a sex hormone naturally found less in females than in males. This hormone diminishes in the female body with menopause. When researchers compare dry eye rates in men and women by age, they note a correlation between low androgen levels and dry eye. But they haven’t found a direct link yet.

Whether the cause of dry eye lies excesses of estrogen or progesterone or deficiency of androgen, there seem to be many factors. These factors might only weaken your eyes’ ability to respond to environmental factors.

Hormones & Oral Contraceptives

A blister packet of oral contraceptives labeled with days of the week

For some reason, hormone replacement therapy (HRT) can interfere with aqueous layer production. For those transitioning to female hormones, these medications artificially introduce estrogen and progesterone.

Oral contraceptives, i.e., birth control pills, can also interrupt lacrimal glands. Moreover, there can be about 29% more dry eye when a patient takes estrogen and progesterone together, instead of estrogen alone.

Environmental Factors

Sometimes your surroundings will dry your tears faster. Because of hormonal changes, the lacrimal or meibomian glands can’t respond to the external stresses placed on them. Dry eye syndrome can develop as your body struggles with humidity, wind, contact lenses, or allergens.

Post-Menopausal Tear Film

Unfortunately, there’s no quick fix to your tear film after you’ve passed through menopause. As mentioned, hormone replacement therapy (HRT) sometimes health patients get HRT from a general practice physician for personal reasons. Other times, they may have an illness affecting their natural hormone levels.

But some studies have tried to test HRT as a remedy for age-related dry eye, with mixed results. Upping estrogen and progesterone, or just estrogen, do not appear to alleviate dry eye in hundreds of female subjects with similar symptoms.

Once menopause is complete, your tear film could suffer from underproduction of tears or underproduction of lipids (oil), no matter the hormones you’re taking. In the same study, HRT actually made dry eye symptoms worse for some.

 Preventative Steps You Can Take for Menopausal Onset Dry Eye

There’s no preventing menopause, but that doesn’t mean you can’t go through it without a healthy tear film. There are a few steps you can take to avoid dry eye if your body has become more susceptible to onset during menopause:

Dry Eye Management

Fortunately, if a woman going through menopause develops dry eye, it can still be managed. That’s to say, dry eye is something you’ll have to live with. Still, there are many avenues your optometrist can navigate with you, providing you with relief without overly impacting your quality of life.

These solutions can range from dietary planning to supplementary tears and even to prosthetics. We also prescribe Restasis and Xiidra eye drops for targeted symptom relief.

Dry Eye Relief Into Your Golden Years

As long as you can live with dry eye comfortably, we can tailor a dry eye management plan that’s right for you. If you’re undergoing the “changes of life,” as menopause is sometimes referred to, you might be at a greater risk for dry eye. But if you talk to your optometrist about steps you can take, you might be able to mitigate that risk.

Written by Stephen Lobaugh

Dr. Lobaugh is an affiliate doctor with TLC Laser Eye Centers, a position that allows him to effectively co-manage a variety of refractive surgeries including LASIK, PRK, and KAMRA inlay. He is also certified by the International Association of Board of Examiners in the treatment and management of ocular disease.

More Articles By Stephen Lobaugh

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