Dry Eye Disease in Perimenopause

Ask Your…. Gynecologist???

Many women experience new ocular problems during the menopause transition affecting their vision, comfort, and quality of life. Common symptoms include dry, itching eyes, a feeling that something foreign is in the eye, blurred vision, light sensitivity (photophobia), and/or a burning sensation. The cause may be Dry Eye Disease (DED), a tear-production disorder. Women are more at risk of DED than men, especially during the menopause transition when hormones are changing. Symptoms may begin in perimenopause and worsen after menopause if not treated.

Ovarian hormone production has a protective effect on the development of DED prior to menopause. Reduced synthesis of estrogen and androgens after menopause causes changes in the lacrimal (tear duct) and meibomian (eyelid) glands leading to deficiencies in tear production, tear quality (fewer lipids), and inflammation in the mucous membranes of the eyes (kerato-conjunctiva). Physicians, usually gynecologists, play a critical role in providing appropriate treatment for women with menopause-related symptoms such as hot flashes. 

However, since most women do not associate symptoms of DED with menopause and therefore may not tell their provider. Emerging research suggests that early initiation of hormone therapy (HT) may be beneficial in restoring tear production and quality. Women who start HT at an earlier age benefit the most, however, HT may be beneficial to older women too. Emerging evidence suggests estradiol eye drops may reduce moderate-to-severe symptoms of DED in women who are post-menopause.   

Midlife women experiencing a new onset of dry, itchy eyes or other symptoms of DED should consult with their healthcare provider. HT may be a viable treatment option for making vision more comfortable.