Dry Eyes During Menopause

Published: August 3, 2017

Not many women know that menopause can affect your eyes. The fluctuations in hormones result in irritated, dry, red and/or itchy eyes in over 60 percent of perimenopausal and menopausal women. Known as chronic dry eye, if left untreated, it can seriously affect your vision and overall health of the eyes.

Read more to learn the reasons behind chronic dry eye and how to prevent and relieve it during the menopause transition and beyond.

What is Chronic Dry Eye (also known as Dry Eye Syndrome)?

It is one of the most common conditions associated with the menopause transition. Yet, only 16 percent of the estimated 61 percent of perimenopausal and menopausal women suffering with chronic dry eye realize that their hormones are likely to blame. More than an estimated 3 million women over 50 suffer from dry eye.

A common condition, dry eye occurs when the quality or the quantity of the tears are not optimal in keeping the eye surface moist and healthy. The cornea is the “window”, the clear front surface, of the eyes. A healthy tear film over the cornea is critical in having excellent vision, protecting against environmental challenges, and maintaining a healthy clear surface. Chronic dry eye occurs when the amount of tears produced is not enough, the tears are of poor quality or contain inflammatory byproducts, or the tears evaporate too quickly. This can lead to dry eye symptoms initially and if left untreated can have a long-term impact on vision as a result of scarring.

Chronic dry eye often causes irritated, gritty, scratchy, red or burning eyes. It can be very uncomfortable and cause excess watering and blurred vision. It sometimes feels like a constant eye irritation, an inability to tolerate contact lenses, and difficulty focusing on tasks like reading or working on the computer. The eyes feel tired and over-worked. The symptoms may be occasional early in the start of the condition and situational, occurring when the eyes are challenged. You may first notice problems when on an airplane, in an air-conditioned room, while riding a bike, or after looking at a computer screen for a few hours. These are early signs which should be shared with your eye care specialist.

Who Gets Dry Eye?

Although it can occur at any age, dry eye is more common in people older than 50, especially women. A lack of tears or poor quality tears are more common when hormonal changes due to the menopausal transition occur. It may also be associated with certain medical conditions, medications, dietary changes or environmental factors.

Women with medical conditions such as diabetes, rheumatoid arthritis, lupus, scleroderma, Sjogren’s syndrome, thyroid disorders, and vitamin A deficiency, are especially susceptible.

Medications are another common cause. These include treatments for high blood pressure, acne, birth control and Parkinson’s disease. Dry eye is also linked to antihistamines, decongestants, some antidepressants, and some pain relievers. Women taking hormone replacement therapy (HRT) medications have a 70 percent greater chance of getting dry eye.

While dry eye is more common after menopause, women who experience menopause prematurely, due to surgery, for instance, are more likely to have eye surface damage from dry eye.

 What Causes Chronic Dry Eye?

The cause is simple – a lack of tears or poor quality tears. Your tears are a complex mixture of water, oils and mucus. This mixture makes the surface of your eyes smooth and clear, and it helps protect them.

According to the National Eye Institute, there are two types of dry eye:

  1. Aqueous tear-deficient dry eye is when you’re not producing enough tears to maintain eye health. It’s thought to be due to inflammation in the gland which produces tears, resulting in lack of normal function of the gland. This type of chronic dry eye is due to low tear production.
  2. Evaporative dry eye is caused from an inflammation of the meibomian glands, blockage of the gland opening or poor lipid quality in the meibum produced by these glands These glands are located in the eyelid and normally produce an oily substance that prevents the evaporation of tears. When the problem arises from the lack of this oily top layer, the dry eye is due to increased tear evaporation.

Common causes of decreased tear production include:

  • Aging
  • Menopause
  • Certain medical conditions (see above)
  • Certain medications (see above)
  • Laser eye surgery (although this is usually temporary)
  • Tear gland damage from inflammation or radiation

Common causes of increased tear evaporation include:

  • Wind, smoke or dry air
  • Blinking too little, especially when concentrating or looking at a computer screen
  • Eyelid problems, such as out-turning of the lids and in-turning of the lids
  • hormonal changes
  • long term contact lens use
  • Rosacea

What are the Symptoms of Dry Eye?

Dry eye can be a temporary or a chronic condition. Signs and symptoms usually affect both eyes at the same time. These include:

  • Stinging or burning of the eye
  • A sandy or gritty feeling as if something is in the eye
  • Episodes of excess tears following very dry eye periods
  • A stringy discharge from the eye
  • Pain and redness of the eye
  • Episodes of blurred vision
  • Heavy eyelids
  • Inability to cry when emotionally stressed
  • Uncomfortable contact lenses
  • Decreased tolerance of reading, working on the computer or any activity that requires sustained visual attention
  • Eye fatigue

If you have one or more of these symptoms for more than a few weeks, consult with an eye care professional. There are two types of eye care doctors. An ophthalmologist is a medical doctor who specializes in eye health, offering both medical and surgical treatment of eye conditions. An optometrist is a doctor of optometry who provides primary eye care ranging from vision correction to the diagnosis and medical treatment of eye diseases.

Visit the National Eye Institute to find a professional eye care professional near you. He or she can provide you with diagnosis and treatment options to avoid permanent damage to your eyes.

How is Dry Eye Syndrome Diagnosed?

There are a number of tests and procedures that an eye exam with an eye care professional can use to diagnose your dry eye. Your doctor will ask you about your history and overall health. He or she may also use one of several tests to check the quality and the quantity of the tear film in your eyes.

Your eye care professional may measure the volume of your tears using the Schirmer test. In this test, he or she may place a special blotting strip of paper under your lower lids and measure the amount of tears on the strip after five minutes.

To measure the quality of your tears, your doctor might use a special dye in eye drops to determine the surface condition of your eyes. He or she will look at staining patterns on your corneas and measure how long it takes for your tears to evaporate.

There are also specialized tests to determine the presence of inflammatory byproducts in the tear film. This could help delineate the underlying cause of the chronic dry eye. There are also in-office tear film analysis tests to determine the salt concentration (tear osmolarity) of the tear and compare to normal ranges. Lastly, there are imaging devices which help in looking at the quality of the tear film, the speed by which it evaporates, the health of the meibomian glands and the blink function of the eyelids. An eye care professional, when alerted to your symptoms, can take the steps necessary to determine the cause of your condition and in turn offer the best treatment for your specific problem.

How is Chronic Dry Eye Treated?

Milder symptoms (red, itchy, tired eyes) can be relieved with rest, environmental changes, use of over-the-counter lubricating eye drops, or by minimizing the amount of time in contact lenses. If the symptoms persist or get worse, your eye care professional may need to manage your dry eye syndrome as an ongoing condition.

In cases of persistent problems, the first priority will be to determine if a disease (such as Sjögren’s syndrome or lacrimal and meibomian gland dysfunction) is the underlying problem. If so, it will need to be treated to prevent long-term damage and worsening of the condition.

Cyclosporine, an anti-inflammatory medication, is the only prescription eyedrop proven to increase tear production in patients with chronic dry eye. By lowering the inflammation in the tear-producing gland of the eye, it increases basic tear production, decreases corneal damage, and reduces symptoms of dry eye. Continued use, twice daily, has been shown to slow or stop the progression of chronic dry eye disease. Its safety and efficacy has been proven through numerous studies since its introduction in 2003. In some cases of severe dry eye, short term use of corticosteroid eye drops that decrease inflammation is required at the outset to help speed the recovery. Cyclosporine is also the only preservative-free, prescription eye drop available in a multidose bottle, in addition to single-use vials.

Lifitigrast was recently approved for treatment of signs and symptoms of dry eyes. It is an immunomodulator and helps lower the inflammation in the tear film of those with chronic dry eye disease. As experience with this new treatment option grows, more information about its use and efficacy will become available.

If dry eye results from taking a medication, your eye care professional may recommend switching to a medication that does not cause the dry eye side effect.

In severe cases where contact lens wear is the problem, your eye care professional may recommend another type of lens or reducing the number of hours you wear your lenses. In the case of severe dry eye, your eye care professional may advise you to opt for glasses over contacts.

Another option for severe dry eye is to plug the small circular openings at the inner corners of the eyelids where tears drain from the eye into the nose. Plugs can be inserted into these holes painlessly by an eye care professional. The patient usually does not feel them. In severe and chronic cases, if a permanent closure is necessary, a simple surgery can close the drainage holes.

In some patients with dry eye, supplements or dietary sources (such as tuna fish) of omega-3 fatty acids (especially DHA and EPA) may decrease symptoms of irritation. The use and dosage of nutritional supplements and vitamins should be discussed with your primary healthcare provider.

In cases in which the oil producing glands of the eyelids are blocked, an in-office treatment to open the glands and express the backed-up oil may be offered as a maintenance treatment. Medications by mouth which may include antibiotics to convert the thickened oil to a more healthy consistency may be needed too for a short period of time. Daily warm compresses and eyelid cleansing may also be helpful for maintenance.

What Self-Management Steps Can I Take?

For some women with occasional dry eye symptoms related to the menopause transition, it’s enough to regularly use over-the-counter eye drops or artificial tears. However, if your symptoms persist and if you feel reliant on daily use of eye drops for relief, see an eye care professional to help delineate the underlying cause and seek treatment to prevent worsening of the condition.

In order to support his or her treatment plan for you, there are additional steps you can take to keep your eyes healthy:

  • Blink regularly when reading or working at a computer for long periods. Use an antiglare screen for the computer.
  • Use allergen–reducing eye drops sparingly. Chronic daily use can worsen your symptoms as they have a drying effect on the eye surface.
  • Keep a dry eye journal to learn the triggers that worsen your symptoms. When you can, avoid the conditions that cause your dry eye syndrome to worsen.
  • Increase the humidity in your home and work environments. A small humidifier in the rooms where you spend the most time can be helpful. Avoid fans, and direct air towards the eyes.
  • Wear sunglasses whenever you venture outdoors.
  • Get plenty of eye health nutrients through your diet:
    • Eat plenty of fruits and vegetables, especially those containing vitamin A and beta carotene, such as carrots, sweet potatoes, and tangerines; vitamin C, such as citrus fruits and fruit juices; and vitamin E, such as nut butters and vegetable oils.
    • Take zinc supplements or get plenty in your diet through whole grains, yogurt, cheeses, milk, beans, poultry and meat.
    • Consider nutritional supplements containing essential fatty acids and eat plant based spreads and oily fish such as salmon and tuna. Omega-3 fatty acids can prevent macular degeneration in addition to dry eye syndrome. Women who eat two helpings of tuna per week significantly reduce their risk for dry eye.
  • Drink plenty of water.
  • Quit smoking if you smoke and avoid secondhand smoke.

Summary

In conclusion, dry eye can be an uncomfortable side effect of the menopause transition. It can be painful and even dangerous to your eye health. Don’t ignore dry eye. See an eye care professional for persistent symptoms.

Sources: National Eye Institute, Mayo Clinic, AllAboutVision.com, eMedicine.Medscape.com, MedlinePlus.gov, American Optometric Association

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