Dry eyes are a lesser-known symptom of menopause. Researchers used to assume that dry eyes were caused by low estrogen, but newer studies are investigating the potential role of androgens.

Everyone has a tear film that covers and lubricates the eyes. The tear film is a mixture of water, oil, and mucus.

Dry eyes occur when you don’t produce enough tears or when your tears are ineffective. This can cause a gritty feeling like something is in your eye. It can also lead to stinging, burning, blurry vision, and irritation.

As you age, tear production naturally decreases. This change is often exacerbated by the hormonal fluctuations associated with menopause.

Perimenopause marks the start of a gradual decline in the production of certain sex hormones, including androgens, estrogens, and progesterone.

Androgens may play a role in managing the delicate balance of tear production, but the exact relationship is unknown.

Dry eyes are what doctors call a multifactorial disease, meaning several things may contribute to the condition.

Typically, dry eye problems stem from one or more of the following:

  • decreased tear production
  • tears drying up (tear evaporation)
  • ineffective tears

Common environmental triggers for tear evaporation include:

  • air conditioning
  • allergies
  • contact lenses
  • dry air
  • wind
  • outdoor athletics

The following can also increase your risk:

  • diabetes
  • laser eye surgery
  • Parkinson’s disease
  • regular use of antihistamines
  • thyroid disease

Healthcare professionals typically recommend making certain lifestyle changes and trying an over-the-counter (OTC) medication. If your symptoms persist, your healthcare professional may recommend prescription medication.

Lifestyle changes

  • Limit your screen time: Remember to take breaks if you work at a computer all day. Close your eyes for a few minutes or blink repeatedly for a few seconds.
  • Protect your eyes: Wraparound sunglasses can block wind and dry air. This may be especially helpful when running or biking.
  • Use a humidifier: Moistening the air in your home or office may help.
  • Increase your intake: Omega-3 fatty acids and vitamin A may encourage healthy tear production.
  • Avoid contact lenses: Regular contact lenses can make dry eyes worse. Talk with a healthcare professional about switching to glasses or contact lenses specially designed for dry eyes.

OTC medications

Artificial tears can help ease your symptoms, but it’s important to exercise caution.

Keep the following precautions in mind:

  • Drops with preservatives can irritate your eyes if you use them too much.
  • Drops without preservatives are safe to use more than four times per day. They come in single-serving droppers.
  • Lubricating ointments and gels provide a long lasting thick coating, but they can cloud your vision.
  • Drops that reduce redness can be irritating if used too often.

Prescription medications

Your healthcare professional may prescribe one or more of the following:

  • Drugs to reduce eyelid inflammation: Swelling around the edge of your eyelids can keep necessary oils from mixing with your tears. Oral antibiotics may counter this.
  • Drugs to reduce cornea inflammation: Inflammation on the surface of your eyes can be treated with prescription eye drops. Your healthcare professional may suggest drops that contain the immune-suppressing medication cyclosporine (Restasis) or corticosteroids.
  • Eye inserts: If artificial tears aren’t working, try a tiny insert between your eyelid and eyeball that slowly releases a lubricating substance throughout the day.
  • Drugs that stimulate tears: Cholinergic drugs, such as pilocarpine (Salagen) and cevimeline (Evoxac), help increase tear production. They are available as a pill, gel, or eye drops.
  • Drugs made from your own blood: If you have a severe dry eye that isn’t responding to other treatments, eye drops can be made from your own blood.
  • Special contact lenses: Special contact lenses can help by trapping moisture and protecting your eyes from irritation.

Many people with dry eyes wonder if hormone replacement therapy (HRT) can help them. The answer is unclear.

Among doctors, it’s a source of controversy. Some studies have shown that dry eyes improve with HRT, but others have shown that HRT makes dry eye symptoms more severe. The issue continues to be debated.

Your tears protect your eyes from the outside world. Without them, you have an increased risk of eye infection.

Severe dry eyes can lead to inflammation and abrasions on the eye’s surface. This can cause pain, corneal ulcers, and vision problems.

Menopause causes changes throughout your whole body.

Although more research is needed to understand how hormonal fluctuations interact with the structures in your eyes, it’s clear that menopause is a contributing factor to acute or chronic dry eye.

If you haven’t already, consider making an appointment with a healthcare professional to discuss your symptoms. They can rule out other underlying conditions and advise you on your options for treatment.