(Written by Kiara Yllescas, in conjunction with Sarah Dardarian, I-MED Pharma)
Did you know that woman over the age of 50 have a higher risk of dry eye problems?
According to the American Academy of Ophthalmology, dry eye disease (DED) affects over 3.2 million American women middle aged and over.Hormonal changes associated with menopause make dry eye disease more prevalent among women in this age group, and so it is important to keep ocular health in mind during this life stage.
What is Menopause?
Menopause is a point in time 12 months after a woman’s last period. The menopausal transition, or “perimenopause”, is the years leading to menopause. This transition usually begins around the age of 45 and commonly lasts between 7-10 years. The production of reproductive sex hormones estrogen, androgen, and progesterone fluctuate during menopausal transition and generally remain at low levels after menopause.
Menopausal transition, menopause, and post-menopause (the lasting stage after menopause with no menstruation) come with a multitude of symptoms such as hot flashes, dry eyes, insomnia, and mood swings.,  This stage of life brings changes in health which can be overwhelming, and difficult to navigate. This post will provide insight on how menopause can affect the eyes as well as provide some management options to help keep your eyes both comfortable and healthy, but remember, always discuss any ocular concerns or issues with your primary eye care provider. Keep reading to learn more about how menopause and each hormone can affect ocular health.
How Does Menopause Affect Ocular Health?
Menopause results in fluctuating levels of hormone production – often leading to a hormonal imbalance – which can affect the Meibomian glands. These tiny glands are located within the lid margins and produce oil which coats the surface of the eye and prevents the tear film from evaporating too quickly, which is a key component for keeping the eyes hydrated. 
Lower hormonal levels can affect the Meibomian glands’ mechanisms, which in turn can make the tear film unstable and can lead to ocular surface dryness.
Changing estrogen levels can affect the oil glands in the eye, as well as the structure. This is because estrogen promotes elasticity in the cornea causing the cornea to become stiffer. The unstable levels affect the eyes by way of dryness and blurry vision and can result in DED.
Progesterone works with estrogen to support the eye’s Meibomian glands. While there are less studies on the effects of progesterone on ocular health alone, Hormone Replacement Therapy (HRT) may be prescribed to women experiencing symptoms from menopausal transition and can be prescribed as either estrogen-only or a combination of estrogen and progesterone.
Hormone Replacement Therapy (HRT)
Many women look to combat their menopausal symptoms with Hormone Replacement Therapy (HRT). HRT is a medication that contains female hormones and is commonly used to treat menopausal symptoms. While the benefits may outweigh the risks, HRT increases the chances of blood clots, stroke, and breast cancer. Data suggests women who use HRT can also be at an increased risk, and severity for DED. Some studies even suggest that the estrogen only HRT option may have detrimental effects on the tear film.
Dry Eye Management and Treatment Solutions
Due to the relationship between dry eye disease and menopause we cannot rule dry eye as a temporary condition. Most women’s hormones remain at a low level after menopausal transition. Fortunately, this multifactorial condition has a variety of management options and treatment solutions available which focus on alleviating discomforting ocular symptoms. These options include:
Eye drops are a standard management option as they provide hydrating relief to dry eye sufferers experiencing anything from mild discomfort to severe constant pain. A preservative-free option is best as it limits further damage to the ocular surface. A high-quality eye drop works by enhancing the three natural layers of the tear film – the mucin layer, the aqueous layer, and the lipid layer – and should closely mimic the natural tear film. This gives the ocular surface extra lubrication, hydration, and relief.
Dry Eye Ointments
Ointments work to relieve discomfort and offer hydration to the eyes. They also support the lubrication of the cornea and conjunctiva. Ointments, such as I-DEFENCE®, are typically on the eyes longer, thus are recommended for overnight use.
Punctal plugs are small biocompatible devices that can be inserted into tear ducts to block drainage. The result of punctal plug insertion is increased moisture in the tear film. This helps relieve certain forms of dry eye while also reducing tear flow.
Nutrition plays a big role in ocular health. Omega-3 fatty acids are helpful to both our physical and ocular health. Oral consumption of re-esterified Omega-3 fatty acids has been associated to statistical improvement in tear osmolarity. It can be difficult for many people to meet the daily recommended amount of omega-3 fatty acids from diet alone; a daily omega-3 nutritional supplement is an easy way to reach the recommended amount.
Moist heat therapy using an eye therapy mask, such as I-RELIEF® Hot & Cold Therapy Mask, or a compress made from a warm, moist towel over the eyes is a form of supplementary therapy that can provide immediate relief. Lightly massaging the eyelid in between sessions can help improve oil gland functions. This therapy is helpful as it can also provide an instantly hydrating and soothing relief.
Environment is one of the many factors which contribute to dry eye disease. Home heating and cooling systems such as furnaces and air conditioners decrease humidity in the air. Consider using a humidifier to add moisture to the air. Tears will evaporate more slowly with a humid environment and add more moisture back to dry eyes.
When to see your doctor
Many women continue to experience side effects from low hormone levels in this stage and have an increased risk for health conditions. The connection between dry eye disease and menopause are closely related with the effects possibly lasting long thereafter due to lower hormonal levels post-menopause. Maintaining a good routine for your eyes is important to relieve current and future discomfort from ocular surface conditions including dry eye, blepharitis, and Meibomian Gland Dysfunction (MGD).
The first step in getting relief for dry eye disease is to reach out to an eye care professional (ECP). It is important to schedule an appointment for a dry eye evaluation and diagnostic testing to evaluate your dry eye symptoms. In addition to lubricating eye drops, which are commonly recommended, other ocular surface disease products such as the ones listed above may be useful in alleviating discomforting ocular symptoms. Find a clinic near you that carries I-MED Pharma products and discover which dry eye management and treatment solutions are right for you.
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 “Post menopause: Signs, Symptoms & What to Expect.” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/21837-postmenopause#:~:text=Postmenopause%20is%20a%20term%20to,longer%20ovulating%20(releasing%20eggs).
 Boyd, Kierstan. “How Hormones Can Affect Eyes and Vision.” American Academy of Ophthalmology, 12 Nov. 2018, https://www.aao.org/eye-health/tips-prevention/how-hormones-can-affect-eyes-vision
 “Menopause and HRT: Hormone Replacement Therapy Types and Side Effects.” WebMD, WebMD, https://www.webmd.com/menopause/guide/menopause-hormone-therapy.
 Debra A. Schaumberg, ScD. “Hormone Replacement Therapy and Dry Eye Syndrome.” JAMA, JAMA Network, 7 Nov. 2001.
 Epitropoulos, Alice T. MD; Donnenfeld, Eric D. MD; Shah, Zubin A. MPH; Holland, Edward J. MD; Gross, Michael MD; Faulkner, William J. MD; Matossian, Cynthia MD; Lane, Stephen S. MD; Toyos, Melissa MD; Bucci, Frank A. Jr MD; Perry, Henry D. MD Effect of Oral Re-esterified Omega-3 Nutritional Supplementation on Dry Eyes, Cornea: September 2016 – Volume 35 – Issue 9 – p 1185-1191