Dry Eye in Perimenopause and Menopause
Contact lenses that were previously comfortable beginning to sting, a burning sensation in the eyes at the computer, an image that becomes blurred from time to time while reading… Eye complaints arising during perimenopause and menopause may affect working life and everyday comfort.
These complaints should not be attributed to tiredness or advancing age alone. Hormonal changes may affect the tear system; dry eye can also begin before periods have stopped completely.
In Op. Dr. Gökay Günay’s dry eye assessment, the eye complaints of women in perimenopause and menopause are given particular attention. The onset of the complaints, their effect on everyday life, the medication in use and current treatments are assessed together with a detailed eye examination.
Does Menopause Cause Dry Eye?
Hormonal changes during perimenopause and menopause may affect tear production and the function of the oil glands in the eyelids. When the structure of the tears that protects the ocular surface is disturbed, faster evaporation, burning and stinging may be seen.
However, not every case of dry eye beginning at this age is caused by hormones alone. Screen use, contact lenses, certain medications, eyelid conditions and accompanying health problems should also be assessed.
Can Dry Eye Begin in Perimenopause, While Periods Are Continuing?
Yes. In perimenopause, the transitional period before menopause, dry eye may begin while periods are still continuing, or existing complaints may become more noticeable.
Dry eye does not on its own establish a diagnosis of perimenopause. Changes in the menstrual cycle, any hormone treatments in use and other medication should be shared at the eye examination.
Burning, Stinging and Blurred Vision in Menopause
Dry eye does not always present with the feeling that “my eye is dry”. The complaints that may be seen during this period are as follows:
- Burning, stinging and a gritty sensation in the eyes
- Increasing discomfort while using a computer or a phone
- Blurred vision that improves briefly on blinking
- Less comfort with contact lenses than before
- Redness and, at times, excessive watering
- Sensitivity in wind or in air-conditioned environments
Fluctuating vision may be related to the tear film. That said, not every episode of blurring is dryness; other structures such as the spectacle prescription, the natural lens, the cornea and the retina should also be assessed.
What Is Assessed in a Dry Eye Examination?
The assessment begins by discussing the complaints and with a general eye examination. Alongside the level of vision and the need for glasses, the cornea, conjunctiva, eyelids and lash margins are examined. Assessment of the other parts of the eye is completed according to the examination findings.
To understand the cause of the dryness, the following investigations may be carried out where required:
- Assessment of how long the tear film keeps its integrity after blinking
- Examination with dyes of surface changes in the cornea and conjunctiva caused by dryness
- Measurement of the quantity of tears and, where required, of tear production
- Assessment of the openings and secretions of the meibomian glands in the eyelid
- Imaging of the structure of these glands with meibography where appropriate
Not every patient needs to undergo all of these tests. Investigations are selected according to the complaints and the examination findings; the results are interpreted together.
How Is Dry Eye Treated in Menopause?
Treatment is planned according to whether there is insufficient tear production, increased evaporation, inflammatory changes on the ocular surface, or a combination of these.
Artificial tear drops, gels or ointments where required, lid hygiene and prescription ocular surface treatments may be used. The composition of the drop and how often it is used are determined on an individual basis.
Where there is dysfunction of the lid glands, controlled warm compresses and, in suitable patients, additional methods such as IPL may be assessed. In selected patients, punctal plugs intended to keep tears on the ocular surface for longer may be considered.
Being in perimenopause or menopause does not on its own mean that a particular device-based treatment is required. The findings on the ocular surface determine the choice of treatment.
Does Hormone Treatment Resolve Dry Eye?
It cannot be said that hormone treatment used for menopause will necessarily improve dry eye. The effects on the ocular surface may vary from person to person; dryness may continue while hormone treatment is being used.
The name of the medication in use, when it was started and its relationship to the complaints are assessed at the examination. The decision to start, change or stop hormone treatment should be made with the relevant physician. Medication should not be changed independently because of dry eye.
What Can Be Done in Everyday Life to Relieve the Eyes?
Taking regular breaks in front of a screen, remembering to blink and preventing air-conditioned air from blowing directly onto the face may help. Protection from wind and smoke may also reduce complaints.
The wearing time and suitability of contact lenses may be reassessed. If lid hygiene or warm compresses have been advised, the way they are applied and how often should be arranged according to the physician’s instructions.
These measures support treatment; where complaints persist, they do not replace an examination.
Assessment and Follow-Up During Perimenopause and Menopause
Follow-up considers not only the test results but also the comfort felt while reading, working and wearing contact lenses. The response to treatment and the need for drops are reviewed, and the plan is revised where necessary. On matters relating to accompanying conditions or hormone treatment, the relevant physicians may be contacted with the patient’s consent.
Frequently Asked Questions
If My Eye Is Dry, Why Is It Watering?
Irritation of the ocular surface may lead to reflex watering. For this reason, watering does not rule out dry eye. However, other causes such as allergy and problems with the tear drainage ducts may also be investigated.
Why Have Contact Lenses I Previously Wore Comfortably Begun to Sting?
Changes in the tear film may reduce contact lens comfort. Alongside this, the suitability of the lens, the wearing time, care products and the condition of the ocular surface should also be assessed. If there is pain or redness, the lens should be removed and an eye examination carried out.
I Use Artificial Tears but My Complaints Are Not Resolving. What Should I Do?
The drop being used may not be sufficient for the type or severity of the dryness. Accompanying causes such as dysfunction of the lid glands and inflammatory changes on the ocular surface should be reassessed. The answer is not always to use the drop more often; the treatment plan is reviewed.
Does Dry Eye Resolve on Its Own After Menopause?
It should not be assumed that the complaints will resolve completely on their own. Symptoms may fluctuate over time or may persist. The need for treatment and check-ups is determined on an individual basis.
I Have a Dry Mouth as Well as Dry Eyes. Is That Important?
A persistently dry mouth, joint complaints or marked fatigue should be mentioned at the examination. Rather than being attributed to menopause alone, these complaints should also be assessed for other possible causes such as Sjögren’s disease.
For Which Symptoms Should I Not Wait?
An eye assessment is required without delay in the event of sudden reduced vision, severe eye pain, marked sensitivity to light or rapidly increasing redness.
This information is for general guidance only; it does not replace individual medical assessment. Suitability for treatment is determined by examination.