Menopause and Dry Eye: Causes, Treatments, and Impact on Vision
All articles and on blog posts on mEYEspa are created and edited by Dr. Jason Morris from clinical experience and research. Unlike all others, this post on Menopause Dry Eye had AI assistance due to the vast amount of data and references beyond eye care literature. We will always be clear about AI-assisted research for posts.
Perimenopause and menopause dramatically change body physiology. It is common in clinic to have women on hormone-replacement-therapy or discuss other symptoms associated with menopause but be unsure or unaware these life changes can also their eyes. Eyes can feel dry, gritty or vision can fluctuate on blinking. These can be associated with the hormonal changes of menopause.
This blog explores symptoms, prevalence, causes and the treatment of Menopause Dry Eye
Studies suggest the vast majority of menopausal women experience dry eye symptoms such as chronic irritation and fluctuating vision during this life transition. (AllAboutVision.com)
In this post, we’ll explore why menopause can trigger dry eye, whether it’s caused by eye lid issues (MGD), lack of watery tears (aqueous tear deficiency) and how hormone replacement therapy (HRT) might help or worsen the condition.
We’ll also discuss whether menopause dry eye can affect your vision and explore tips and product suggestions to find relief.
Why Menopause Causes Dry Eyes in the majority of Women
Menopause brings hormonal fluctuations that can affect the entire body – including eyes. As we age, our tear chemistry changes and menopause’s hormonal fluctuations often exacerbate this imbalance.
Menopause brings hormonal fluctuations that can affect the entire body – including eyes. As we age, our tear chemistry changes and menopause’s hormonal fluctuations often exacerbate this imbalance.
During perimenopause and menopause, estrogen and androgens levels decline. These hormones play a role in maintaining healthy eyes. In particular, a drop in androgens is thought to impact the glands that keep eyes moist. Androgens normally support both the oil-producing meibomian glands in the eyelids and the watery tear-producing lacrimal glands (optometrists.org). With lower hormone levels, these glands may become less effective: oil glands can get blocked or inflamed, and lacrimal glands may produce fewer tears.
The end result of this is thinner, less stable tear films. Tears may evaporate too quickly without enough oil, or there may simply be fewer tears being made. This leads to classic dry eye symptoms – burning, redness, scratchy or “gritty” feeling, excessive reflex tearing, and even blurred vision as the tear film becomes uneven.
Many women in menopause are surprised to find their eyes watering a lot; paradoxically, this can be a sign of dryness because the eye is irritated and producing reflex tears that lack the proper oil balance.
What's to blame?
Low Oils?
Low Water?
Or Both?
Dry eye can stem from meibomian gland dysfunction (MGD) (also called oil/lipid-deficient or evaporative dry eye) or from aqueous tear deficiency (not producing enough watery tears).
In menopausal dry eye, both mechanisms are often at play. Hormonal changes commonly trigger MGD – in fact, reduced hormones around menopause generally cause MGD, which then results in dry eye. MGD means the oil layer of the tears is lacking, so tears evaporate too fast.
At the same time, tear production can also diminish, leading to an aqueous deficiency. Eye doctors often classify dry eye into these two forms for treatment purposes, but they can occur concurrently.
In practice, many menopausal women have a mix of evaporative and aqueous dry eye. It’s worth noting that MGD (evaporative dry eye) is extremely common – it’s considered the most common form of dry eye overall– so it often dominates the clinical picture in menopause. However, an eye exam can determine if your dry eye has more of an oil deficiency component, a tear quantity issue, or both.
Understanding this helps target the right treatment (since management of MGD vs. aqueous deficiency can differ). Often, treating the meibomian gland dysfunction (e.g. unclogging glands and improving the oil layer) provides significant relief, while also addressing general tear production and quality.
HRT and Dry Eye: Help or Hindrance?
You might wonder whether hormone replacement therapy (HRT) – often used to ease menopause symptoms – will relieve or worsen dry eye. The relationship between HRT and dry eye is surprisingly complex and somewhat controversial. Some studies have shown dry eye symptoms improve when menopausal women take hormone therapy, but other studies have found the opposite.
Notably, research has linked estrogen-only HRT to a higher risk of dry eye. One large study indicated that women on HRT (especially estrogen alone) were significantly more likely to develop dry eye syndrome (optometrists.org). In fact, patients using hormone therapy were about four to seven times more likely to have dry eye symptoms in that analysis.
The exact reasons aren’t fully understood, but some scientists suspect that excess estrogen without enough androgens could negatively affect the tear film. Androgens are known to support the oil glands, so a therapy that doesn’t replace androgens might remove that protective effect. That said, the medical community hasn’t reached a firm consensus – the HRT-dry eye link is still debated.
If you are on HRT or considering it, it’s important to monitor your eyes. HRT may help some women’s dry eye and worsen others’. Discuss any changes in your vision or comfort with your medical doctor. In some cases, adjusting the type of hormone therapy (for example, adding progesterone, or using the lowest effective dose) might mitigate dry eye side effects. Always consult your primary healthcare provider about what’s best for your overall health.
Can Menopause-Related Dry Eye Affect Vision?
Yes – menopause dry eye can definitely affect your vision, especially if it’s not managed. A healthy tear film is essential for clear eyesight; it forms the first refractive surface of the eye. When your tears evaporate too quickly or you don’t have enough, the tear film becomes unstable, leading to fluctuations in vision. You might notice that your vision gets blurry or filmy and clears up after blinking, only to blur again.
This kind of intermittent blurred vision is a common dry eye symptom (optometrists.org). It can make tasks like reading, computer work, or driving uncomfortable because your sight isn’t consistently clear. In most cases, treating the dry eye will stabilize your vision. However, if dry eye is severe or chronic and left untreated, it can cause more serious ocular surface damage. Without adequate tears, the cornea (the clear front of the eye) can develop inflammation and even microscopic abrasions or ulcers, which may lead to pain and persistent vision problems (healthline.com). In other words, long-term dry eye can permanently affect vision by damaging the cornea. The good news is that such complications are preventable – with proper care, menopausal dry eye is usually manageable and should not lead to vision loss. If you’re experiencing significant dryness or changes in your sight, see an eye care professional for an evaluation before it worsens.
Tips for Managing Menopause Dry Eye
There are many ways to relieve dry eye symptoms and protect your eyes during menopause. From simple home remedies to specialized eye products, here are some practical strategies:
- Use lubricating eye drops frequently: Regularly instill non-preserved artificial tears to keep your eyes moist. It’s best to choose these preservative-free drops if you use them often. Look for drops in disposable single-use vials or special multi-dose bottles. For example, a drop like Thealoz Duo® can both hydrate and protect the surface for evaporation. Hyabak® eye drops come in a filtered bottle that keeps them preservative-free hydrate the eyes very well. Using these 2–4 times a day or as needed can greatly improve comfort.
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Apply warm compresses to your eyelids: A properly applied warm compress helps unblock and stimulate your meibomian glands, improving the oily layer of your tears. Trial by closing your eyes and placing a warm (not hot) moist cloth on your lids for several minutes. This can work for some but most women will need more the sustained heat from a moist heat mask.
A microwavable eye mask like the Bruder Mask to deliver consistent warmth works wonders. Five minutes each morning and evening can make a big difference in tear quality. Following the warm compress, gently massage your eyelids to express the oils, if instructed by your eye doctor. -
Practice good eyelid hygiene: Keeping your eyelid margins clean can help with chronic eyelid inflammation (blepharitis) that often accompanies MGD. After a warm compress, you can gently cleanse your lash lines with a lid wipe or a diluted baby shampoo solution (or use specialty lid cleansers). This removes debris and bacteria, reducing irritation.
Regular eyelid hygiene is a recommended part of dry eye management(optometrists.org). It’s also highly recommended to completely remove all eye makeup thoroughly each night. And a quick makeup tip: avoid applying eyeliner on the inner rim of your lids (the waterline) – doing so can block the meibomian gland openings. -
Omega-3 supplements: Omega-3 fatty acids (from fish oil) have been shown to support healthy tear film composition. Many eye doctors recommend an omega-3 supplement to patients with menopause dry eye, as it tends to improve the oil layer of tears and reduce inflammation.
For example in our clinic, taking about 1200–2000 mg of omega-3 daily is often suggested (check with your doctor first, especially if you’re on blood thinners). Eating oily fish like salmon or adding flax/chia to your diet can also boost omega-3 intake naturally. - For extreme menopause dry eye use a nighttime ointment or gel: If you wake up with very dry, irritated eyes, adding a lubricating eye gel or ointment at bedtime can help. These thicker lubricants coat the eye for longer periods. A vitamin A eye ointment like Ocunox® can be applied before sleep to keep eyes comfortable overnight. (Just note that gels/ointments can blur vision while in the eye, so they’re for nighttime use.)
- Stay hydrated and humidify your environment: Simple lifestyle tweaks go a long way. Drink plenty of water throughout the day to stay hydrated (your eyes need general body hydration to produce tears). If you live in a dry climate or spend winter months in heated indoor air, consider using a humidifier in your bedroom or office to add moisture to the air. Humidity levels greatly impact dry eye symptomology
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Give your eyes regular breaks: If you spend a lot of time on screens or tasks that require intense focus, you’re likely blinking less, which worsens dry eye. Follow the 20-20-20 rule (every 20 minutes, look at something 20 feet away for at least 20 seconds) or simply close your eyes for short rests.
Deliberately blink more often to refresh your tear film. Also, lower your computer screen slightly below eye level – this way your eyelids naturally stay a bit more closed and cover more of your eye, reducing evaporation(optometrists.org). - Protect your eyes from drying factors: Avoid direct drafts on your eyes – for instance, don’t let car vents or fans blow straight at your face(optometrists.org). If you’re in a windy or arid environment, wear wraparound sunglasses or glasses to shield your eyes. This helps prevent the wind from accelerating tear film break-up.
Lastly, if your dry eye symptoms are significant or not improving with self-care, see your eye doctor. They may recommend additional therapies such as prescription anti-inflammatory drops (like cyclosporine), punctal plugs (tiny inserts that help retain tears), or other treatments tailored to your needs
Don’t hesitate to seek professional help – you deserve comfortable vision. Menopause is a time of big changes, but dealing with menopause dry eye doesn’t have to diminish your quality of life. With a combination of healthy habits and the right treatments, most women find real relief. Be patient and consistent with your dry eye regimen, and work with your healthcare providers to adjust as needed. Your eyes might be dryer these days, but with care and attention, they can stay happy and see clearly through this new stage of life and beyond.
- Dr. Morris, J. Dry Eye Basics. mEYEspa at Studio Eye Care meyespa.com.
- Lazarus, R. Dry Eye and Menopause. Optometrists Network optometrists.org.
- Sprabary, A. Dry Eyes and Menopause. All About Vision (2023) allaboutvision.com.
- Menopause and Dry Eyes: What’s the Link? Healthline (Reviewed 2020)healthline.com.
- mEYEspa Dry Eye Product Recommendations – Aqueous & Lipid Deficiency Guides meyespa.com.
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Away from corporate influences and their churn, I believe in time and an unhurried environment. At mEYEspa and my clinic, we are UNcorporate Optometry. I have special interest in occupational vision needs, concussive injury to the visual system and dry eye management. I am the owner of mEYEspa and a dedicated to the delivery of relevant information and clinic-tested eye care products. -Doctor of Optometry - University of Waterloo 1994 -Honors Bachelor of Science – Waterloo 1994 -Registered Ontario College of Optometrists -Member of Ontario Association of Optometrists -Member of Canadian Association of Optometrists -10 year straight winner of 3 Best Rated Optometrists London ON
