5 min

MENOPAUSEAND DRY EYES

PROFESSOR DAWN SIM, OPHTHALMIC SURGEON AT MOORFIELDS EYE HOSPITAL, CO-FOUNDER AT MTHK

“Menopause is similar to puberty - but in reverse. It's a time when we undergo huge hormonal changes.”

PROFESSOR DAWN SIM, CONSULTANT OPHTHALMIC SURGEON AT MOORFIELDS EYE HOSPITAL, CO-FOUNDER AT MTHK.

Can menopause affect your eyes?

Eye surgeon explains the link

Hot flushes, mood swings, night sweats - symptoms we all recognise as part of menopause. But not many people make the link between menopause and eye health. It can take years for menopause to present itself, and very often, the first signs manifest in your eyes.

Up to 60% of menopausal women may experience red eyes, blurred vision, a scratchy or stinging feeling in the eye, or a build-up of mucus along the eyelids. These are all indicators of Dry Eye, which affects twice as many women as men over the age of 50. We break down exactly what goes on with your eyes during menopause and some helpful (science-based) advice to help you manage.

Read Our Guide To Dry Eyes

“During menopause, the oils that keep your eyes nourished and moisturised, turn from an olive oil, silky smoothness to a sticky, toothpaste-like consistency. This leads to scratching and inflammation as your eyeballs move around their sockets.”

PROFESSOR DAWN SIM, CONSULTANT OPHTHALMIC SURGEON AT MOORFIELDS EYE HOSPITAL, CO-FOUNDER AT MTHK.

menopause eye treatment - how to manage the symptoms

Get more rest: Tiredness makes a huge difference to the eyes in menopause, so try to get as much sleep as possible, and allow your eyes to rest. This means minimising time spent on screens when possible, and taking regular screen breaks when it’s not.
Eat for your eyes: The oils you ingest impact the oil makeup in your glands. Opt for foods rich in Omega-3 and 6, such as oily fish, nuts, seeds, eggs and leafy greens to keep your eye’s oil levels in balance. This also helps reduce your risk of cardiovascular, neurodegenerative and osteoporotic disease with menopause.
Clean air: Pollutants, air conditioning and air travel can all play havoc with your eyes. Although these factors are often unavoidable, it’s worth taking extra care of your eyes if you fly regularly or spend long hours in air-conditioned environments.
Regular checks & breaks: Keep your eyes in check by getting regular eye tests and taking breaks from wearing contact lenses. This will help you monitor any changes that might crop up, so you can take steps before things get worse.
Less stress: Stress drives inflammation in the body, making Dry Eye symptoms worse. Anything you do to improve your wellbeing will positively impact your eyes - so make sure you stay socially, physically and cognitively active.
Wash it out: If you’re already feeling the effects of Dry Eye, a hot shower, bath or hot flannel can emulsify the hardened fluid build-up and provide much-needed lubrication to your eyes.
Moisture boost: Eye sprays, anti-inflammatory drops, and wipes are available that help with the cleansing and healing process and provide relief against Dry Eye symptoms.
HRT or not to HRT: Current studies offer differing opinions on whether Hormone Replacement Therapy (HRT) helps or hinders eye health. Taking a pragmatic and holistic approach to eye health during menopause by following some of the tips above would be a good approach.

can hormones affect your eyes?

Dry eyes & hormone imbalance

Any time you go through a transition in hormonal balance, the regulation of certain glands in your body will change. During puberty, biological changes are overshadowed by enormous personal and emotional shifts. With menopause, however, the changes start from a period of relative homeostasis – making them feel much more impactful.

Those going through menopause often assume that Dry Eye is simply a reaction to their body’s natural ageing process and moisture loss. But it’s actually caused by changes to the levels of androgen and oestrogen present in the body. These fluctuations can impact the fluid coating your eye, making it feel dry or irritated.

Online Eye Test

“Once the symptoms of Dry Eye occur, it creates what’s known as an ‘inflammatory cascade’, making it harder to remedy at home without medical treatment”

ALEX IONIDES, CONSULTANT OPHTHALMIC SURGEON AT MOORFIELDS EYE HOSPITAL, CO-FOUNDER AT MTHK.

THE INFLAMMATORY CASCADE

It starts in the meibomian and lacrimal glands, located under you eyelids. These glands secrete lipids (a mixture of fats, oils and hormones). During menopause, the change in hormonal balance causes these lipids to thicken to a toothpaste-like consistency. Over time this may harden, and block some of your glands, leading to scratching and inflammation in your eyes and lids.

Menopause can also affect the goblet cells in your eyes. They produce and secrete less mucins (bottom layer of your tear film) onto the eyes' surface.

Once the symptoms of Dry Eye occur, it creates what’s known as an ‘inflammatory cascade’, making it harder to remedy at home without medical treatment. A combination of prevention and maintenance is essential to prevent this.

Eye Drops + Eye Spray

“1 in 10 women leaves their job because of menopause symptoms. 59% of women take time away from work because of menopause symptoms. 86% of women are unaware of a connection between menopause and their eye health.”

PROFESSOR DAWN SIM, CONSULTANT OPHTHALMIC SURGEON AT MOORFIELDS EYE HOSPITAL, CO-FOUNDER AT MTHK.

Alex Ionides (ophthalmic surgeon) answers your menopause questions

What are the most prevalent symptoms with your eyes during menopause?: Dry, tired gritty eyes. Sometimes red, sore eyes. Your glands (meibomian and lacrimal) and microbiomes in the mucin layer of your tears are affected by hormonal changes during menopause. It's gradual (almost in the background) and increases as perimenopause and menopause progress.
How do you know itchy, dry eyes are down to menopause? Is there a difference between allergies and menopause?: Yes, you can. With allergies, your eyes have a constant itching feeling - and when you look under the microscope, the surface of your eyes looks like cobbled streets. You'll also get morning stickiness (stringy mucus) and possibly an irritated, runny nose. Also likely to trigger asthma. Antihistamines (tablets or drops) can help with this. With menopause, you get a dry, sore, deep achy feeling. You just feel like you want to close your eyes. Drops, sprays and a good, targeted supplement will help alleviate this.
When did you start to come across menopausal eye problems? Was it a surprise? A lightbulb moment?: It has always been known that perimenopause and menopause cause symptoms in your eyes. I'm not sure why it's not talked about more widely.
What can you do to safeguard your eyes as you approach menopause and old age?: Apart from HRT, try and approach it more naturally - a good diet with plenty of omegas and green leafy vegetables. You will have some good days and some (very) bad days. When you're having a bad day - remember that the good days are just over the horizon. It tends to worsen in the wintertime, in urban areas with pollution, or when you've had less sleep. Get yourself some preservative-free drops and sprays - to help you through this. You should see an optician if it becomes unmanageable (even after the drops and sprays).
What are the best home remedies?: During menopause, the secretions from your meibomian glands go from an olive oil to a stiff toothpaste-like consistency. Warm compresses and hot showers help melt these...almost like butter in a pan.
Do they calm down post-menopause – or is it a lifetime condition?: Menopause is a chapter in your life that eventually finishes. Unfortunately, the symptoms can continue for some people.
Can you explain why many women have dry eyes, yet tears stream down their faces?: Your cornea needs this silky, smooth, soothing mucin layer to cover it. During menopause, with the changes in your glands and secretion, you get dry patches on the surface of your eyes. This causes 'reflex tearing' - when you get tears streaming down your face. This tearing doesn't solve the dry patches and creates a vicious loop. The mucus, water and oil in your tear film are out of kilter. Use preservative-free drops and sprays to help stabilise your tear film.
And how do you deal with this runny eye situation?: When you have poor tear quality, the top fat layer in your tear film cannot contain the water layer beneath, resulting in dry patches on the eye's surface. Your eyes respond by tearing – but the issue of dry patches remains. Using a liposomal eye spray reinforces the top fat layer of the tear film and seals in the water layer, removing the dry patches. It may sound counter-intuitive, but when you're tearing excessively, apply more liposomal eye spray - to strengthen and seal your tear film. Eventually, this will stop the dry patches and deal with the streaming tears.
Any makeup products to steer clear of, anything that might exasperate?: That's a whole topic on its own. Dawn's written a separate blog on that. [See link below.]
Do your eyes age?: Yes, they do. With age, you tend to get more redness, yellowness, and sometimes a bumpy vein on the surface. With age, your lids change shape as your skin changes. This affects how your eyelids shut and how they spread tears across the surface of your eyes.
How do you care for the whites of your eyes?: In short, you can't. I suggest you minimise the risk of infections and keep your eyes moisturised. Any drops or sprays must always be preservative-free to avoid sensitivity reactions. There are many vasoconstrictors (stopping or reducing blood to the surface of your eyes) on the market. But the long-term effects have not been studied, and I urge caution. Your eyes can also have a 'rebound' vasodilation when you stop using them, making them redder. And once you've got the redness, it's had to get rid of it.