Dry Eyes and Menopause: Why Hormones Matter for Eye Health
Dry eye disease (DED) — characterised by burning, grittiness, irritation, fluctuating vision, and discomfort — is a very common but often overlooked symptom in perimenopause and menopause. While most people associate menopause with hot flashes or mood changes, the eyes are also vulnerable to hormonal shifts that affect tear production and ocular surface health.
Why Does Dry Eye Increase Around Menopause?
Menopause involves profound changes in sex hormones — especially estrogen, progesterone, and androgens. These hormones don’t just influence reproductive tissues; they also play an important role in maintaining the tear film — the thin layer of moisture that keeps your eyes lubricated and comfortable.
The tear film has three layers — water, oil, and mucus — produced by different glands of the eye:
Aqueous layer (water) from lacrimal glands
Lipid layer (oil) from meibomian glands
Mucin layer from conjunctival goblet cells
Sex steroid receptors exist on these glands, so when hormone levels shift:
tear production may decrease
tear quality can deteriorate
eyelid oil (meibum) becomes thinner
tear evaporation increases
This creates the perfect conditions for dry eye symptoms.
How Common Is Dry Eye in Menopause?
Studies consistently show higher dry eye prevalence in perimenopausal and postmenopausal women. Around 60–68% of women in these age groups report symptoms, and prevalence increases with age.
Despite these numbers, many women don’t realise the connection between their hormonal transition and eye irritation, and may only talk to a professional about the physical symptoms when they become severe.
Hormones and the Eye — The Complex Relationship
The hormonal influence on dry eye isn’t straightforward:
Estrogen
Estrogen receptors are found on tear-producing glands, and the hormone modulates tear composition.
Some evidence links higher estrogen levels or estrogen-only hormone replacement therapy (HRT) with worsened dry eye symptoms.
Androgens
Androgens are critical for healthy lipid (oil) production from meibomian glands, which prevents tear evaporation.
Low androgen states — as seen in menopause — may contribute significantly to dry eye.
Progesterone
Progesterone’s role is less well studied, but because it influences immune regulation and neuroinflammation, it may affect symptoms indirectly.
Bottom line: The hormonal effects on the ocular surface are real — but they vary between individuals and may differ depending on hormone levels, treatment regimens, and underlying eye health.
Hormone Replacement Therapy (HRT) — Help or Harm?
HRT was once thought to be a potential therapy for menopausal dry eye, and some observational studies suggested benefit in tear production or symptoms.
However, key points from the literature include:
Estrogen-only HRT has been associated with increased risk of dry eye in several large studies.
Combined estrogen + progesterone therapy also may increase risk, though the effect appears smaller and more mixed.
Some small studies report improvement with HRT, but results are inconsistent and likely influenced by patient selection and duration of use.
Overall, hormone therapy is not standard treatment for dry eye, and its effects on ocular surface symptoms are variable. Decisions about HRT should focus primarily on menopausal symptomatology and individual risk–benefit discussion with your clinician.
Beyond Hormones — What You Can Do
Dry eye in menopause may require a multi-pronged approach. Effective strategies include:
Lifestyle & Environment
Humidify indoor air
Take regular breaks from screens
Wear wraparound glasses outdoors
These reduce tear evaporation and irritation.
Eyelid & Tear Care
Warm compresses
Lid hygiene
Artificial tears or lubricants
Professional Treatments
Prescription eye drops (e.g. anti-inflammatory)
Tear retention devices like punctal plugs
Meibomian gland-targeted treatments
Regular Eye Exams
Dry eye can worsen over time and contribute to ocular surface damage — early diagnosis and tailored treatment help protect vision and quality of life.
The Take-Home Message
Menopause isn’t just about hot flashes and sleep changes — the eye is an important organ affected by the hormonal transition. Dry eye in menopause is common, often under-recognised, and sometimes misattributed to aging alone. While hormones play a significant role, treatment focuses on symptom control and ocular surface health rather than systemic hormone therapy alone.
If you’re experiencing burning, itching, or fluctuating vision, talk to your healthcare provider — dry eye is treatable, and a tailored plan can make a real difference to comfort and daily functioning.
FAQ
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Yes. Dry, gritty, burning or irritated eyes are a recognised but often overlooked symptom of perimenopause and menopause. Hormonal changes affect tear production and tear quality, making dry eye more common at this life stage.
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Oestrogen, progesterone and androgens all interact with the glands that produce tears and oils for the eye surface. When hormone levels fluctuate or fall, tear stability can be disrupted, leading to dryness and irritation.
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HRT is not a guaranteed treatment for dry eye. Some women notice improvement, others feel no change, and some experience worsening symptoms, particularly with oestrogen-only HRT. Decisions about HRT should be based on overall menopausal symptoms and individual risk–benefit discussion rather than eye symptoms alone.
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Yes. Dry eye becomes increasingly common after menopause, with studies suggesting more than half of postmenopausal women experience symptoms. It is often under-recognised and attributed to ageing rather than hormonal change.
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Treatment usually focuses on eye-specific care, including lubricating eye drops, eyelid hygiene, warm compresses, lifestyle adjustments and prescription anti-inflammatory drops if needed. An optometrist or ophthalmologist can help tailor treatment to the type of dry eye you have. There has been a study in rabbits which has shown an improvement with testosterone treatment, but this has never been tested in women.
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Yes, especially if symptoms are persistent, painful, affecting vision, or not improving with over-the-counter treatments. Dry eye is a medical condition and early management can help prevent progression.