Why Menopause Causes Dry Eye — and What You Can Do About It

Dry eye disease can occur at any age, but there’s a reason many mid-life women with dry eye notice their symptoms worsening around the time of menopause, namely, the changes in hormone levels that occur at this time of life.

If your dry eye seems to be getting worse — or you’ve been diagnosed with dry eye for the first time — during perimenopause or menopause, understanding the connection between menopause and dry eye can help you better manage your symptoms and protect your long-term eye health.

How Hormones Affect Eye Health

• An outer oily (lipid) area that keeps the surface of the tear smooth and slows tear evaporation
• A watery middle layer that keeps the eyes wet, repels bacteria, and protects the cornea
• An inner mucus layer that keeps whole tears fastened to the eyes

"During menopause, the body produces less of the hormones estrogen and progesterone,” Dr. Brissette says. “There is a real link [to DED]. Sex hormones help regulate tear production, tear quality, and oil production from the eyelid oil glands that slow tear evaporation. And dry eye is a combination of lowered tear production and reduced oil production from the eyelid glands.”

Hormonal fluctuations can affect tear production and eye comfort throughout a woman’s life, but menopause is one of the most common triggers, according to Viola Kanevsky, a doctor of optometry based in New York City and a spokesperson for the American Optometric Association.

"This is common during menopause, but pregnancy, lactation, birth control pills, thyroid disease, and menstrual cycle variations can all affect dry eye,” Dr. Kanevsky says. The connection is so common that many eye-care providers routinely discuss menopause with dry eye patients, she says. When asked whether she sees women diagnosed with dry eye around the time of perimenopause or menopause, Kanevsky says, "Every single day."

Can Hormone Therapy Help?

Knowing that hormones affect tear production and play a role in dry eye disease, many women wonder whether hormone therapy (HT) might improve their symptoms.

But the answer isn’t straightforward. It’s not as simple as saying low estrogen causes dry eye and more estrogen will fix it, says Nicole Bajic, MD, an ophthalmologist at the Cole Eye Institute at Cleveland Clinic in Ohio.

“It wasn’t found to necessarily reverse or benefit patients who are postmenopausal with dry eye. And in some cases, it can even make their symptoms a little bit worse,” Dr. Bajic says.

Much more research is needed before suggesting hormone therapy as a dry eye treatment, Brissette says.

"If a patient is considering HRT primarily for other symptoms of menopause, such as hot flashes or sleep disruption, dry eye is something to discuss as a possible coexisting problem," Brissette says. “However, there isn't enough evidence that hormones alone can provide improvement in the signs and symptoms of dry eye disease. It’s generally not the main reason to start HRT."

Starting, continuing, or stopping HRT for dry eye symptoms, alongside other symptoms of menopause, should be discussed with your overall healthcare team, including your ophthalmologist, Brissette says.

Kanevsky agrees. “This is an incredibly important discussion to have at length with your gynecologist,” she says. “I always make a point of sending a dry eye report to my patient's gynecologist and primary care physician because it can make an enormous difference in not just their ocular health but their overall well-being.”

Other Treatments for Menopausal Dry Eye

Women going through menopause can try many treatments and lifestyle changes to manage dry eye symptoms and improve eye comfort.

• Cleaning the eyelids with safe eye hygiene products
• Using a gentle warm compress for 10 minutes before bedtime to increase oil in your tear film
• Taking regular breaks from screens
• Running a humidifier in dry indoor environments
• Avoiding or reducing contact lens use
• Wearing sunglasses or wraparound glasses to avoid excessive wind and UV exposure

According to Kanevsky, these habits can help support eye comfort throughout menopause and beyond.

"I do more long-term prescription therapy that looks at reducing the inflammatory load," she says.