Menopause marks the permanent end of menstruation and fertility, typically occurring between ages of 45-55. It often causes eye problems due to declining oestrogen and progesterone hormones. Common symptoms include chronic dry eyes, a burning sensation in the eyes, blurred vision and light sensitivity.
Menopause is often discussed in terms of hot flashes, bone health, and mood changes. Rarely do we speak about the eyes. Yet, from an ophthalmologist’s perspective, the hormonal transition that defines menopause can significantly influence visual comfort and ocular health.
Tackling dry eyes
Around 60% of the post-menopausal women suffer from dry eyes. It is the most common eye complaint during menopause. Evaporative dry eye, the most common form of dry eye diseases, causes stinging, burning and the sensation of a foreign body in the eye, not only because of decreased tear production, but also due to inflammation and dysfunction of oil secreting glands in the lid. Nowadays, the quantification of dry eye disease can easily be done via dry eye diagnostic machines.
Management may involve the use of preservative-free lubricating eye drops and gels to replenish depleted tear components, the dilution of inflammatory substances, and minimising osmotic stress on the ocular surface. Warm compresses and lid massage can help improve the function of the eyelids’ oil-secreting glands.
In some circumstances, doctors may prescribe oral drugs such as doxycycline, omega-3 fatty acid supplements, or anti-inflammatory eye drops, especially in moderate to severe diseases. Newer treatments, such as light pulsation therapy, may help repair the tear film’s lipid layer and improve meibomian gland activity. Where appropriate, limiting long-term screen exposure and consulting with a healthcare provider about hormone replacement treatment may be recommended.
Changes in vision
A lot of women experience changing spectacle strength around the time of menopause. Hormonal changes may affect corneal curvature and thickness, leading to temporary variations in refractive errors.
Ocular surface and eyelid diseases
Blepharitis (inflammation of eyelid margins) as well as ocular surface irritation are often exacerbated in the menopausal period. Worsened tear quality disrupts the eye’s innate protective barrier, raising the risk for irritation and infection.
Hormone replacement therapy (HRT) has had variable effects. Some studies indicate a potential exacerbation of dry eye syndrome by oestrogen-only therapy, while combined regimens demonstrate variable outcomes. Decisions regarding HRT should be individualised and addressed with both gynaecologists and ophthalmologists in those individuals who have ocular symptoms.
Glaucoma and retinal health
Menopause itself is not a direct cause of glaucoma, but some studies have found that younger age at menopause is associated with a modestly increased risk. As such, regular ocular examinations with emphasis on intraocular pressure recording, together with optic nerve evaluation, are recommended.
Likewise, hormonal changes might affect retinal vascular homeostasis. Conditions like age-related macular degeneration (AMD) are more common in women, though this reflects both longevity and complex biological factors.
Cataract surgery
Oestrogen has anti-oxidant properties that offer some protection to the natural lens of the eye. Due to its decline after menopause, cataract development may accelerate. Increased risks for macular degeneration are also reported post-menopause. Cataract surgery in post-menopausal women exacerbates dry eye symptoms with symptoms persisting 2-3 months post-surgery. Hence starting a lubricant 15 days prior to surgery may help alleviate symptoms.
Regular check-ups
Menopause is a part of the ageing process and not a disease. Its effect though, extends to the eyes, more often than women realise. So if you do experience the above symptoms, do not hesitate to get a comprehensive eye evaluation done by a trained ophthalmologist and cornea specialist every six months.
(Dr. Saumya Sharma is a consultant ophthalmologist at Dr Agarwals Eye Hospital, Delhi. saumyathedoctor@gmail.com)
