To paraphrase Jane Austen, it is a truth universally acknowledged that a woman approaching midlife will experience physical changes that will take her by surprise. Take, for example, dry eyes. Turns out, this chronic eye condition is highly common among women in perimenopause and beyond.
Hilda Hernandez Nash says her symptoms sprung up earlier this year, as she was driving to work one morning. "All of a sudden I couldn't tolerate my contacts," she recalls. "My eyes just felt like they were sandpaper."
Within days, her eyes became red, watery and swollen. At one point, she says, her eyes had trouble focusing. "I just didn't want to open my eyes. I couldn't tolerate the light."
At first, Hernandez Nash, who is in her late 40s, thought she might have some form of pink eye. But when she saw an eye doctor, she learned her symptoms all pointed to dry eyes. Research suggests around half of all women in the menopausal transition years experience symptoms.
"Dry eye is incredibly common," says Lauren Gormley, an optometrist and assistant professor of ophthalmology with the Wilmer Eye Institute at Johns Hopkins University School of Medicine. While men get dry eyes too, "large-scale studies have shown that the rate of dry eye in women over 50 is double the rate of dry eye in men over 50." And the prevalence increases with age.
The role of hormones
Gormley says the condition occurs when your eyes can't produce enough tears or they dry up too quickly. And one of the most common causes is a problem with the meibomian glands, the oil glands in the eyelids that keep tears from drying up too fast.
"The oil can be ineffective, the oil volume can be too low, the oil could be too thick, or the oil could not be able to be released into the tear film," Gormley says. "And that is where the connection comes into menopause."
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She says that's because sex hormones – in particular androgens – help regulate oil production in these glands. As androgen levels decline with age and menopause, the oil glands in eyes produce less and lower quality oil, "which then leads to faster evaporation of the tears and then increased inflammation of the ocular surface, which is really what dry eye is," Gormley says.
The lacrimal glands, which produce the watery part of tears, contain estrogen receptors, and it's likely that shifts in estrogen levels also play a role in dry eyes in women, although there is still a lot we don't know, says Dr. Kelly Nichols, dean of the School of Optometry at the University of Alabama at Birmingham.
And there are lots of other factors that can contribute to dry eyes, Nichols says. "Unfortunately, we're around computers a lot – all day, every day."
When we stare at screens, we blink less frequently, so our tears don't spread as well. Wearing contacts can also cause dry eyes, as can many common medications, such as blood pressure drugs and antidepressants. So can allergies and skin conditions like rosacea and eczema.
The effect on day-to-day life
Nichols says research has shown dry eyes can influence everyday life, from being less functional at work to problems reading and driving.
"I would say, should you go to the doctor? Yes. Because your eyes shouldn't impact your quality of life," Nichols says.
And dry eye symptoms shouldn't be ignored, because the condition can get worse, says Preeya Gupta, an ophthalmologist in Raleigh, N.C., and dry eye disease researcher. As the disease progresses, the surface cells of the cornea can actually start to break down, she says.
"When that happens, that will cause your vision to be blurry. And it can put you at increased risk for infection and scarring of the cornea," says Gupta.
She says especially if you're experiencing symptoms like irritation, fluctuation in vision or redness, it's worth going to see an eye care doctor.
Treatment options
Dry eyes are a chronic condition, so there is no cure. But these days, a wide range of treatments are available that can offer relief – from at-home remedies like warm compresses and over-the-counter eye drops to prescription medications. There's also in-office procedures designed to help the oil glands in your eyelids work better, although those can be pricey and are often not covered by insurance.
Gormley says lifestyle changes can also help, like reducing screen time and taking more breaks from screens throughout the day. She recommends eating plenty of foods like salmon, walnuts and flaxseeds that are rich in omega-3 fatty acids to help improve the function of the oil glands in eyelids. While the research on omega-3 supplements for dry eyes has yielded mixed results, both Gormley and Gupta say anecdotally, they've seen patients benefit from consuming them.
Gormley says it often takes a bit of detective work to figure out all the factors that might be contributing to an individual patient's dry eyes – and some trial and error to find the right combination of treatments that work for each case.
"Once you start to identify where the dry eye is coming from and you start to treat the dry eye that the patient has," Gormley says, " it makes a huge difference."
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