Dry eye disease is a condition that can disrupt your daily life with symptoms like stinging, burning, redness or even tears that roll down your cheeks. For women in midlife, this issue can become even more prevalent, with approximately 61% of perimenopausal or menopausal women experiencing dry eye symptoms, according to Dr. James Dello Russo, a renowned optometrist with family-run Dello Russo Laser Vision and managing director of New Jersey Eye Center.
“As women approach perimenopause and menopause, there is a reduction in estrogen, progesterone and androgens,” Russo, known for his celebrity clientele, tells Flow Space. “This can cause symptoms such as night sweating, hot flashes, insomnia, mood changes and dry eyes. As estrogen and androgen levels decline in women, it can directly impact the lacrimal glands and meibomian glands.”
Russo says these glands are responsible for producing the essential components of tears—aqueous and oily layers—that maintain tear film stability. Without them functioning properly, tears can evaporate too quickly, leaving the eyes dry and irritated.
Symptoms of dry eye can vary widely; some symptoms can present as burning, stinging, red eyes, foreign body sensation or feeling like an eyelash is in the eye—and even teary eyes.
A less obvious sign is fluctuating vision.
“The tear film on the eye contributes approximately 10% of the refractive power of the eye, and when the tear film is unstable, the vision may go in and out of focus, causing women to have to blink excessively to clear up their vision,” Russo explains.
The good news is relief is possible. But before diving into treatments, it’s crucial to first understand the underlying cause of your dry eye symptoms.
What Causes Dry Eye in Women?
Dry eye disease is multifactorial, meaning it can have numerous causes, both internal and external. Russo explains that certain medications—such as antihistamines, birth control, antidepressants and anti-anxiety drugs—can contribute to dry eye. He also highlights that certain health conditions, like diabetes and autoimmune diseases, can play a role in dry eye development.
Environmental factors are another significant contributor, impacting people of all ages.
“Work and leisure habits, particularly excessive screen time, have led to a substantial increase in dry eye sufferers,” Russo says. “Younger women, who may spend over seven hours a day on digital devices, also often suffer from this condition.”
The most common form of dry eye is evaporative dry eye, which is primarily caused by meibomian gland dysfunction. The meibomian glands produce an essential oil called meibum, which helps maintain tear film stability by preventing moisture from evaporating too quickly.
When these glands aren’t functioning properly, the tear film becomes unstable, and this can lead to dry eye symptoms.
“Meibum is critical in allowing even distribution of tears across the ocular surface and serves as a barrier to the surface of the tear film, preventing evaporation of the moisture on the ocular surface,” Russo says.
Certain conditions, like acne rosacea, can cause clogging and inflammation of the meibomian glands, further worsening dry eye symptoms. Another contributing factor is the reduction in blinking that happens when we stare at screens.
“When people stare at computer screens, they blink 50% less frequently on average,” Russo explains. “This can have a severe impact on tear production and lead to excess evaporation of the tear film.”
Start With Basic Care and Environmental Adjustments for Dry Eye Symptoms
If you’re experiencing dry eye symptoms, Dr. Beth Muckley, director of optometric services at Northeast Ohio Eye Surgeons, emphasizes the importance of a thorough diagnosis.
“There are numerous ways to treat dry eyes, but first, you need to have a comprehensive eye exam by a doctor of optometry to determine why the eyes are dry,” she says. “Determining the reason for the dryness helps guide treatment protocols.”
“Starting with preservative-free over-the-counter artificial tears used consistently two to four times every day is typically the first step,” Muckley says.
In addition, tear gels or nighttime ointments can also provide relief, especially during sleep. For women whose symptoms are exacerbated by digital device use or environmental factors, modifications can make a significant difference.
“Modification of your environment is also recommended—no ceiling fans, taking visual breaks during digital device use and running a vaporizer or humidifier can improve symptoms as well,” Muckley says.
If poor oil quality in the tear film is the culprit, Muckley suggests implementing eyelid hygiene routines, such as warm compresses.
“It may be that the oil layer of the tear film is of poor quality due to plugged-up oil glands in the lids,” she explains. “Implementing lid hygiene with warm compresses can help improve symptoms, along with using a more oil-based over-the-counter artificial tear to help supplement the deficient oil layer.”
Consider Hormonal and Prescription Treatments
Hormonal changes during midlife can play a significant role in the development and severity of dry eye symptoms, particularly for women as they approach perimenopause and menopause.
“The lacrimal glands and meibomian glands may be subject to inflammation and, therefore, stunt tear production as hormone levels decline in menopausal-aged women,” Russo says.
This decline affects the delicate balance of tear production, contributing to symptoms like irritation, blurred vision and even reflex tearing.
“Prescription medications to treat the chronic inflammation, such as topical cyclosporine or ophthalmic lifitegrast, are the next steps and need to be managed by your optometrist,” Muckley says.
In cases where tear production is severely compromised, punctal plugs may offer relief.
“Punctal plugs, which are microscopic silicone stoppers, can be placed into both the upper and lower tear ducts to prevent the natural tears from draining, keeping the tears in place on the surface,” says Muckley.
Explore Advanced Treatments for Severe Cases
For women with chronic severe dry eye, Muckley says more advanced procedures may be necessary.
“If those steps do not improve symptoms, there are more advanced procedures and medications that can be implemented,” she says. “It can sometimes take up to three months for treatment to work.”
Beyond the physical impact, dry eye can take an emotional toll. Muckley emphasizes the importance of patient counseling and setting realistic expectations.
“Optometrists counsel patients on dry eye disease and expectations of prognosis by explaining the condition etiologies, outlining the available therapies, setting a treatment plan and providing time needed to see improvement,” Muckley says. “This helps patients manage the emotional considerations, just like with any other disease or problem of the body.”
Dry eye symptoms can significantly impact quality of life, but there are effective treatments for mild, moderate and severe cases. If you’re experiencing dry eye symptoms, schedule a comprehensive eye exam with an optometrist.
“Everyone should have a comprehensive eye exam annually as part of their routine primary wellness care, regardless of needing glasses or corrective eyewear,” Muckley says.
With the right care and a tailored treatment plan, relief is within reach.