Women’s Health Today

Barbara Higham says dry eyes in menopause are literally something to cry about.

As we age, some bits of us will start to dry out. Once you are a woman of “a certain age”—as if wrinkles and a lack of moisture in other mucous membranes weren’t quite enough to put up with—dry eyes might also become a problem for you.

Dry eyes are more prevalent in women and specifically in the menopausal and postmenopausal age group. Large-scale epidemiological studies in the United States have shown that the rate of dry eye syndrome in women over 50 years old is nearly double that in men over 50 (Aggarwal, Peck, & Olsakovsky, 2017).

The definition and classification of Dry Eye Disease (DED) from the International Dry Eye WorkShop (2007) says it is a “multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.” 

DED, also known as keratoconjunctivitis sicca, can cause debilitating symptoms including:

• burning
• a tired feeling
• foreign body/gritty/scratchy sensation
• blurred vision
• oddly, an increase in tears
• light sensitivity
• inflammation

and can therefore affect more or less whatever you do in your daily life. Symptoms are aggravated by noxious agents (e.g. cooking fumes, tobacco smoke) and by increased evaporation of tears (e.g. air conditioning, central heating).

The changes that occur in menopause in the balance of your sex hormones—estrogens and androgens—influence production of all components of the tear film in our eyes. As our bodies age, we produce fewer tears and that makes the eyes vulnerable to infection. Tears are a solution of oils, proteins and electrolytes that essentially protect the eyes by lubricating and nourishing them. The tears we shed protect them from irritants that get into them. An excessive production of tears, watering eyes, is a symptom of DED that does not seem to make sense and you likely were not expecting. Possibly our bodies recognize that more lubrication is needed and overcompensate for the lack of moisture by making more tears.

Whether you are menopausal or young, try to protect your eyes by avoiding the irritants in the air (smoke, dust) as much as possible. Don’t rub them! Use a humidifier if you have an overheated home. Wearing glasses when it’s windy or sunglasses when it’s bright may help, and avoid prolonged use of contact lenses. One simple yet effective way to keep lubricating your eyes is to blink more often!

Lubrication is the first line of treatment recommended for dry eyes and over-the-counter eye drops may provide relief. Systemic and topical omega-3 fatty acids and omega-6 fatty acids have been used recently as an additional treatment for dry eyes (Rand & Asbell, 2011). You can get them by eating fish or taking supplements.

It is clear from the research that alteration of sex hormones plays an important role in the pathophysiology of DED in perimenopausal and menopausal women. Yet DED remains very underrecognized in this group. Few women are aware that their symptoms of dry eyes have any connection with menopause and a physician will not always make that connection either. If you suffer from diabetes, rheumatoid arthritis or a thyroid disorder, unfortunately you are considerably more likely as you age to be troubled by DED as well.

Often, simple measures such as lubricating eye drops or creams will provide relief, decreasing tear outflow, and reducing eyelid inflammation. In more severe cases, anti-inflammatory, immunomodulatory, and rarely surgical interventions are required. New hormonal replacement treatments, both systemic and topical, are also evolving (AlAwlaqi & Hammadeh, 2016; Dawson, 2015) but the exact relationship between HRT and dry eye remains debatable.

Don’t suffer in silence. Speak to your healthcare providers about DED so they can help you find a suitable treatment and direct you towards ophthalmologic intervention where applicable.

References

Aggarwal, S., Peck, T., & Olsakovsky, L. (2017). Dry eye syndrome in menopause and perimenopausal age group. Journal of Mid-Life Health, 8(2), 51. doi:10.4103/jmh.jmh_41_17

AlAwlaqi, A., & Hammadeh, M. (2016). Examining the relationship between hormone therapy and dry-eye syndrome in postmenopausal women. Menopause, 23(5), 550–555. doi:10.1097/gme.0000000000000570

Dawson, T. (2015).Testosterone eye drops: A novel treatment for dry eye disease. Ophthalmology Times.

Rand, A. L., & Asbell, P. A. (2011). Nutritional supplements for dry eye syndrome. Current Opinion in Ophthalmology, 22(4), 279–282. doi:10.1097/icu.0b013e3283477d23

Report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007) Ocul Surf. 2007;5:75–92.

More on the Menopause

Breastfeeding Without Birthing: Hormones

Genitourinary Syndrome of Menopause (GSM): What is it?

How To Be In The Moment

How to Take Care of Your Pelvic Floor

Let’s Talk Menopause 

Osteoporosis Prevention: What You Can Do Right Now