Dry Eyes and Menopause

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As an ophthalmologist, I've spent years helping patients manage dry eye disease. Like many eye doctors, I often talked about screen time, blinking less, air conditioning, allergies, and contact lenses. Those are all important factors, but recently I found myself experiencing something I hadn't fully connected on a personal level.

After turning 50, I noticed I could no longer comfortably wear my daily contact lenses all day. By early afternoon, my eyes felt dry, irritated, and uncomfortable. I found myself swapping out my contacts between patients just to make it through the workday. At first, I blamed my schedule, my screens, and the dry office environment.

Then I realized something much bigger was happening.

During a recent episode of In Focus, I explored the connection between menopause, hormones, and dry eyes. It's a conversation that every woman deserves to hear because what many assume is simply "part of getting older" may actually be a symptom of hormonal changes that deserve attention.

Dry Eyes Are Far More Common Than Most Women Realize

Many women expect hot flashes or changes in their menstrual cycle during perimenopause and menopause. Very few expect their vision to become less comfortable.

Yet dry eye disease is incredibly common during this stage of life.

Research has found that nearly two-thirds of women between the ages of 41 and 60 experience dry eye symptoms, and those symptoms often begin during perimenopause, long before menopause officially begins.

For many women, the first signs aren't obvious.

You may notice your contact lenses become uncomfortable halfway through the day. Your vision may fluctuate while working at the computer. Your eyes may burn, sting, water excessively, or constantly feel tired.

Because these symptoms develop gradually, many women simply assume they're spending too much time on screens or aren't getting enough sleep.

While those factors certainly contribute, hormones often play a much larger role than most people realize.

Your Tears Are More Complex Than You Think

Most people think tears are simply water.

In reality, your tear film is made up of three specialized layers that work together to keep your eyes healthy and your vision clear.

The bottom mucin layer helps tears adhere to the surface of the eye. The middle aqueous layer provides moisture. The outer oily layer prevents those tears from evaporating too quickly.

That outer oil layer is incredibly important.

Without it, moisture evaporates rapidly, leaving the surface of the eye exposed. The result is chronic irritation, inflammation, blurry vision, and the uncomfortable feeling that something is constantly sitting on your eye.

The glands responsible for producing that protective oil are called meibomian glands, and they rely heavily on androgens, particularly testosterone, to function properly.

Why Testosterone Matters for Eye Health

When people think about hormones during menopause, estrogen usually dominates the conversation.

Testosterone rarely does.

That surprised me as well.

During my conversation with Dr. Kelly Casperson, a board-certified urologist and menopause educator, we discussed something many women have never been told: testosterone plays an essential role throughout the female body, including the eyes.

As androgen levels naturally decline during perimenopause, the meibomian glands begin producing less oil. The oil they do produce becomes thicker and less effective, allowing tears to evaporate more quickly.

The result is evaporative dry eye disease.

This isn't simply an inconvenience. A healthy tear film is essential for clear vision. When the tear film becomes unstable, vision quality suffers alongside comfort.

Hormonal Changes Affect More Than Your Eyes

One reason this conversation resonated so deeply is because dry eyes rarely happen in isolation.

Many women experiencing hormonal decline also notice fatigue, brain fog, difficulty concentrating, declining muscle mass, reduced motivation, lower libido, and changes in mood.

These symptoms often appear gradually over years, making them easy to dismiss as stress or simply getting older.

The reality is that androgen levels begin declining much earlier than most women realize. By midlife, many women have lost a significant portion of the testosterone their bodies once produced naturally.

Recognizing these symptoms as potentially connected rather than isolated problems can completely change the conversation you have with your physician.

Small Changes Can Make a Big Difference

While hormones may be contributing to dry eyes, there are several practical strategies that can significantly improve comfort.

One of the first places I encourage patients to start is with their environment.

Dry indoor air, fans, air conditioning, and prolonged screen use all increase tear evaporation. Using a humidifier and positioning your computer monitor slightly below eye level can help reduce exposure of the eye's surface, allowing tears to last longer.

Regular breaks from screens are equally important. Even something as simple as intentionally blinking more often throughout the workday helps squeeze healthy oils from the eyelid glands.

Daily eyelid hygiene can also make a meaningful difference.

Warm compresses applied for several minutes help soften the thickened oils trapped inside the meibomian glands. Following this with gentle eyelid cleansing helps reduce inflammation along the eyelid margin and supports healthier gland function over time.

These simple habits won't reverse hormonal changes, but they often improve symptoms significantly.

When It's Time to Have a Bigger Conversation

For some women, environmental changes and eye care routines simply aren't enough.

If dry eyes are accompanied by other symptoms of hormonal decline, it may be worth discussing the bigger picture with your healthcare provider.

As an ophthalmologist, I don't prescribe hormone replacement therapy, and every woman's situation is unique. But I do believe women deserve informed conversations about all of the factors that may be contributing to their symptoms.

Unfortunately, many women discover there are still gaps in knowledge surrounding female testosterone and menopause. Some clinicians are very comfortable discussing it, while others are less familiar with current research.

That makes self-advocacy especially important.

If you're experiencing persistent symptoms that affect your quality of life, ask questions. Discuss your concerns openly. Seek providers who stay current with menopause research and who are willing to evaluate your symptoms as a whole rather than dismissing them as "normal aging."

Final Thoughts

One of the biggest lessons from this conversation is that women often become experts at caring for everyone except themselves.

We organize our families, manage careers, coordinate schedules, and push through discomfort because that's simply what we've always done.

But persistent dry eyes, constant fatigue, brain fog, or declining energy shouldn't automatically be accepted as the price of getting older.

Sometimes they're your body's way of asking for attention.

Taking care of your eye health isn't vanity or convenience. Healthy vision affects how you work, drive, read, connect with others, and experience everyday life.

If your eyes have been trying to tell you something, it's worth listening.

Advocate for yourself. Ask questions. Explore your options. And remember that caring for your family's health should always include caring for your own.

Want to Learn More?

You can subscribe to my podcast, In Focus, anywhere you listen — or follow along on Instagram for updates and tips.

Watch this episode on YouTube right now!

Thanks for reading — and for doing what you can to protect your family's vision, health, and well-being, one step at a time.

– Dr. Rupa Wong
Pediatric Ophthalmologist | Surgeon | Mom of 3

This episode is brought to you by The Pinnacle Podcast Network! Learn more about Pinnacle at learnatpinnacle.com