Dry Eyes During Perimenopause and Menopause

If your eyes have started feeling gritty, tired, or irritated, and eye drops are becoming a regular part of your routine, perimenopause could be the reason. Dry eye disease is significantly more common in women than men, and the menopause transition is a key trigger.

Why Perimenopause Affects Your Eyes

Your tear film, the thin layer of moisture that keeps your eyes comfortable and your vision clear, depends on a delicate balance of water, oil, and mucus. Hormones play a direct role in maintaining this balance.

Research published in Survey of Ophthalmology identified estrogen and androgen receptors in the lacrimal glands (which produce the watery component of tears), the meibomian glands (which produce the oily component), and the conjunctiva (the membrane covering the white of the eye). When hormone levels shift during perimenopause, all three components of the tear film can be affected (Sullivan et al., 2002).

The Women's Health Study, which followed over 25,000 women, found that the prevalence of dry eye increased with age and was significantly associated with the menopause transition. Women who had gone through menopause had a 15 percent higher risk of dry eye compared to premenopausal women of the same age (Schaumberg et al., 2003).

Symptoms of Hormonal Dry Eye

Dry eye during perimenopause can feel different from the occasional dryness everyone experiences:

A persistent gritty or sandy feeling, particularly later in the day
Stinging or burning sensations
Eyes that water excessively (paradoxically, this is a dry eye symptom, as your eyes overcompensate for underlying dryness with low-quality tears)
Blurred vision that improves temporarily after blinking
Sensitivity to light or wind
Tired eyes, especially after reading or screen use
Discomfort with contact lenses that previously felt fine

These symptoms often appear gradually and can fluctuate alongside other perimenopause symptoms.

What Helps

Artificial Tears and Lubricants

Over-the-counter artificial tears are the first line of treatment. A few things to keep in mind:

Preservative-free formulations are gentler for frequent use. A study in the British Journal of Ophthalmology found that preservatives in eye drops (particularly benzalkonium chloride) can worsen eye surface damage over time
Thicker gel drops provide longer-lasting relief but can blur vision temporarily
For nighttime dryness, ointment-based lubricants applied before sleep keep eyes moist through the night

Warm Compresses and Lid Hygiene

Many cases of dry eye involve meibomian gland dysfunction, where the oil-producing glands in the eyelids become blocked. Research in Clinical and Experimental Ophthalmology found that warm compress therapy (10 minutes daily) improved meibomian gland function and reduced dry eye symptoms. This is a simple, free intervention that many women find effective.

Omega-3 Fatty Acids

There is reasonable evidence for omega-3 supplementation. A study in Cornea found that omega-3 fatty acid supplements improved tear quality and reduced eye surface inflammation. The DREAM study, a large randomised trial published in the New England Journal of Medicine, had mixed results, but a 2023 meta-analysis in the British Journal of Ophthalmology concluded that omega-3s provide modest but meaningful benefit for dry eye symptoms.

Omega-3s are also recommended for broader perimenopause health, as covered in our nutrition guide.

Screen Habits

Extended screen time reduces your blink rate by up to 60 percent according to research in Optometry and Vision Science. During perimenopause, when your tear film is already compromised, this makes things worse. Practical adjustments include:

Following the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds
Positioning your screen slightly below eye level so your eyelids cover more of the eye surface
Using a humidifier in your workspace, especially in air-conditioned or heated rooms

Hormone Therapy Considerations

The relationship between hormone therapy and dry eye is complex. Some research suggests HRT may actually worsen dry eye symptoms, while other studies show benefit. The Women's Health Study found a slightly increased risk of dry eye with HRT use.

If you are considering HRT for other symptoms like hot flashes or sleep problems, discuss your eye symptoms with both your doctor and optometrist to weigh the balance for your specific situation.

Prescription Options

If over-the-counter measures are not enough, your eye doctor can prescribe:

Cyclosporine eye drops (Restasis): reduces inflammation on the eye surface. A Cochrane Review found it effective for moderate to severe dry eye
Lifitegrast (Xiidra): another anti-inflammatory drop approved for dry eye
Punctal plugs: tiny silicone plugs inserted into the tear drainage ducts to keep tears on the eye surface longer. A simple, reversible procedure

The Bigger Picture

Dry eyes during perimenopause often appear alongside other changes driven by the same hormonal shifts:

Dry skin and changes in skin texture
Vaginal dryness from similar tissue changes
Dry mouth, another mucous membrane affected by hormonal changes
Hair and nail changes

These symptoms share a common thread: declining estrogen affects tissues throughout the body that depend on it for moisture and elasticity.

When to See an Eye Doctor

See an optometrist or ophthalmologist if:

Dry eye symptoms are persistent and worsening
Over-the-counter drops are not providing adequate relief
Your vision is affected
You have redness, discharge, or pain (which could indicate infection)
You want to continue wearing contact lenses comfortably

Eye examinations can also detect other midlife eye health changes, including early signs of glaucoma and macular degeneration, making regular check-ups worthwhile regardless of dry eye symptoms.

Sources:

Sullivan, D.A. et al. (2002). Androgen influence on the meibomian gland. Investigative Ophthalmology and Visual Science, 43(12), 3698-3710
Schaumberg, D.A. et al. (2003). Hormone replacement therapy and dry eye syndrome. JAMA, 286(17), 2114-2119
Women's Health Study, Brigham and Women's Hospital, Harvard Medical School
Asbell, P.A. et al. (2018). n-3 Fatty acid supplementation for the treatment of dry eye disease (DREAM study). New England Journal of Medicine, 378, 1681-1690
Tsubota, K. et al. (2020). New perspectives on dry eye definition and diagnosis. Eye, 34, 31-47