For many women, the first signs of perimenopause are not always the ones they expect.
Hot flashes, sleep changes, mood shifts, and irregular cycles are now widely discussed. But for women in their 40s and early 50s, another frustrating symptom can quietly appear: dry, burning, itchy, or irritated eyes.
At our clinic, we often see patients who describe eye discomfort that seems to come out of nowhere. At first, it may feel like mild dryness at the end of the day. Some notice increased light sensitivity. Others describe vision that seems to blur or fluctuate in environments that previously caused no issues. However, one thing is consistent, as time progresses, the symptoms get worse.
Frustratingly, these symptoms can also be wildly inconsistent. One day may feel manageable, while the next feels unbearable. Artificial tears will help briefly, but the relief does not last or the drops will be required to be used numerous times throughout the day.
For years, these symptoms were often blamed on aging, screen time, dehydration, or fatigue. While those factors can certainly contribute, research now suggests that hormonal changes during perimenopause may play a much larger role.
Hormones Affect More Than Meets the Eye
Perimenopause is marked by shifting levels of estrogen, progesterone, and androgens. These hormones are regularly discussed in relation to reproductive health, but they also influence the health of the cornea (the delicate front surface of the eye).
The National Eye Institute notes that hormonal changes during menopause can make it harder for the body to produce healthy tears. Research has also shown that hormone receptors are present in the meibomian glands, the tiny oil-producing glands along both the upper and lower eyelids.
These glands are especially important because they produce the oily layer of the tears. Without a healthy oil layer, tears evaporate too quickly, leaving the eye exposed to irritation, inflammation, and discomfort. This is a common form of dry eye known as evaporative dry eye.
The TFOS DEWS II report also identifies androgen deficiency as a risk factor for meibomian gland dysfunction and both aqueous-deficient and evaporative dry eye.
Shifting Symptoms Require Targeted Treatments
Dry eye related to hormonal change does not always behave predictably. Some women notice symptoms that are more prevalent in the evening. Others feel worse with extended screen use, while driving, or when reading. In some cases, contact lenses or makeup that previously felt comfortable, now cause extreme irritation and redness.
Although counterintuitive, some women may experience tearing instead of a dryness feeling to their eyes. That is because dry eye is not only about the quantity of tears, but also about the quality and stability of those tears. For this reason, artificial tears may be limited in their effectiveness since they may not address the root cause of the dryness if the issue involves inflammation, poor tear quality, or meibomian gland dysfunction.
A more complete dry eye evaluation should include assessing tear film stability, eyelid health, meibomian gland function, inflammation, and the health of the ocular surface. This helps determine where treatment should be focused.
A More Complete Approach to Women’s Eye Health
As the understanding of women’s health continues to evolve, it is becoming clear that dry eye symptoms during perimenopause require more individualized attention.
For women experiencing persistent symptoms associated to dry eye, a complete eye exam including a dry eye assessment is critical in identifying the underlying causes and guiding a more targeted treatment plan. Contact us for more information.