In this guide
- Why menopause can affect your eyes, and why watery eyes can still be dry eyes
- The signs to look out for
- How dry eye is diagnosed, and what can help at home and in practice
- What we know about HRT, supplements and contact lenses
Hot flushes. Broken sleep. Brain fog. Most of us know the list. But ask a room of women in their 40s and 50s whether menopause can affect their eyes, and many look surprised. Then someone says, “Oh… so that’s what this is?”
Surveys by optical providers and menopause clinics suggest that around half of women in perimenopause and menopause experience dry eye, yet only around one in seven to one in four realise the two can be linked. That means a lot of women quietly put up with gritty, sore or watering eyes for months, sometimes years, without knowing there is a reason, or that there is help.
At HAYDENSWAN Eyecare in Bolnore Village, Haywards Heath, we welcome patients from across Mid Sussex, including Burgess Hill, Cuckfield, Lindfield and Hassocks. This Menopause Awareness Month, here is what we would love every woman to know about her eyes.
Can menopause cause dry eyes?
It can. Healthy tears are not just water. They have three layers: an oil layer on top, a watery layer in the middle and a thin layer of mucus underneath that helps tears spread evenly. The oil layer matters most for comfort, because it stops your tears evaporating too quickly. It is made by tiny glands in your eyelids, called meibomian glands.
Hormones, including oestrogen and androgens, are thought to influence how the glands around your eyes work. During perimenopause and menopause these hormones change, and for some women that affects how many tears they make and how well those tears stay on the eye. Women are also more likely than men to develop dry eye, with some studies suggesting up to twice the risk, so it is not in your head and it is not simply “getting older”.
Can low oestrogen cause dry eyes on its own? The picture is more complicated than that. Low androgen levels appear to be a particularly consistent factor, and several things usually add up together, which is why a proper assessment matters.
Why are my eyes watering so much?
It sounds backwards, but watery eyes are one of the most common signs of dry eye. When the surface of the eye is irritated or the tear film is unstable, the eye can overcompensate by flooding with tears. These tears are often poor quality and do not stay on the eye, so you can feel dry and sore and still have tears running down your face, especially in wind or cold air.
There can be other causes of watery eyes too, including a tear drainage problem, which we can check during an assessment.
Signs your eyes may need a dry eye assessment
If several of these sound familiar, it is worth getting your eyes properly checked rather than reaching for another bottle of drops:
- Dry, gritty or sandy eyes, as if there is something in them
- Burning, stinging or redness
- Eyes that water, especially in wind or cold air
- Blurred or “smeary” vision that clears when you blink, or comes and goes
- Tired, heavy eyes by the afternoon
- Contact lenses that suddenly feel uncomfortable
- Waking with dry or sticky eyes
Is it just hormones?
Menopause can be one piece of the puzzle, but dry eye usually has several contributors. Common ones include:
Screen use
We blink up to 60% less when using them, one of the biggest contributors to dry eye symptoms today.
Heating, air conditioning and environment
They dry out the air around your eyes, so your tears evaporate faster, especially through the colder months.
Some medications
Antihistamines, blood pressure medication and antidepressants can affect how many tears you make or how well they work.
Contact lenses
Lenses rely on a stable, healthy tear film, so they can feel uncomfortable or make dryness more noticeable, particularly later in the day.
Eye make-up, lash treatments and skincare
These can sit close to the oil glands in your eyelids and may irritate the lid edge or contribute to blockages, especially if they aren’t removed thoroughly each evening.
Poor sleep, allergies and stress
Tiredness and allergies can irritate the surface of the eye, and eyes often feel worse when you are run down or under pressure
Why are eye drops not always enough?
Many women are simply told to “use eye drops” without anyone finding out why their eyes are uncomfortable. Drops can be a helpful part of the plan, but dry eye is not one single problem. Two women can describe exactly the same symptoms and have completely different causes: blocked oil glands, too few tears, inflamed eyelids, tears that are not draining properly, or a mix of several.
That is why treatment only really starts once there is a diagnosis. The right plan for one woman can be the wrong one for another.
The right plan starts with the right assessment.
How is dry eye diagnosed at our Haywards Heath clinic?
Our Dry Eye Clinic is consultant-led, by an optometrist who also works in NHS hospital ophthalmology and on Harley Street. We never start with a product. We start by finding the cause, in five steps:
- Lifestyle and symptom chat. We ask about your symptoms, screen use, environment, medication, skincare, sleep, allergies and hormones.
- Tear quality and stability. We assess how well your tears protect, hydrate and stay stable on the surface of the eye.
- Oil gland health. We image the glands within your eyelids, because blocked or unhealthy glands are one of the leading causes of dry eye.
- Eye surface health. We check for irritation, inflammation, redness and surface damage.
- A personalised treatment plan. Based on what we find, we build a plan to improve your comfort and support your long-term eye health.
How can I treat dry eyes during menopause?
Treatment depends on the cause, so it is best guided by an assessment. Many women find these general measures a helpful place to start:
- Take regular screen breaks. Try the 20-20-20 rule: every 20 minutes, look away for 20 seconds at something about 20 feet away.
- Blink fully and often when using screens.
- Try preservative-free lubricating drops, and ask your optometrist which type suits you, as not all drops are the same.
- Use a warm compress or heated eye mask and gentle eyelid cleaning, if suitable for you.
- Avoid direct airflow from fans, heaters and car vents towards your face, and protect your eyes from wind.
- Review your eye make-up and skincare around the lash line, and remove make-up thoroughly each evening.
If your eyes are no better after a few weeks of home care, or you are getting worse, it is time for an assessment. In practice, treatment can include deep eyelid cleansing, treatment for blocked glands, tear drainage treatments and specialist therapies, but only when your findings suggest they are right for you. Dry eye is usually a long-term condition that is managed rather than cured, so we will always be honest about what to expect and keep reviewing with you.
Can HRT help dry eyes?
This is one of the questions we hear most. The research is mixed: some women find their eyes feel better on hormone therapy, while for others there is little change, or symptoms can feel worse. Because it varies so much, we do not recommend starting, stopping or changing any menopause treatment because of your eyes. Please talk to your GP or menopause specialist about that, and tell us what you are taking so we can take it into account.
Do omega-3 supplements help dry eyes?
Nutrition, including omega-3, is often discussed for dry eye, and it can be a useful part of a plan for some people. The evidence is mixed, and supplements are not a substitute for finding the cause. If it is relevant to you, we will talk it through as part of your personalised plan.
When should I see an optician about dry eyes?
See us if your eyes still feel dry, gritty or watery after a few weeks of home care, if your symptoms are getting worse, or if you notice any change to your eyes or eyelids. If you are perimenopausal or menopausal, mention it at your appointment, as it helps us build the right plan.
Explore a complimentary Dry Eye Discovery Call, or book a Dry Eye Consultation, and let us find the cause together.
Frequently Asked Questions
Is dry eye in menopause permanent?
For most people dry eye is a long-term condition that can be well managed rather than cured. With the right plan many women feel much more comfortable, and earlier assessment makes it easier to protect the health of the oil glands.
Do I need a dry eye consultation, or is a regular eye test enough?
Every eye examination with us includes a dry eye screening. If your eyes already feel dry, gritty or watery, or the screening suggests we should look further, a Dry Eye Consultation is the next step.
Why are my contact lenses uncomfortable in menopause?
Many women find their contact lenses become less comfortable as their eyes change, because lenses depend on a stable, healthy tear film. We can review your lenses as part of your plan.
Is there a dry eye clinic near me in Haywards Heath?
Yes. HAYDENSWAN Eyecare is in Bolnore Village, Haywards Heath, with a consultant-led Dry Eye Clinic serving patients across Mid Sussex. Late-night appointments are available.
How much is a dry eye consultation?
Our Dry Eye Consultation is £125. You can start with a complimentary Dry Eye Discovery Call, so you can ask questions and find out whether a consultation is right for you.