When you think about Menopause symptoms, what naturally comes to your mind? Most likely, it is hot flashes, insomnia, vaginal dryness, mood swings, fatigue, and headaches. Yet one symptom affects more than 60% of women and most of them don’t even know it is connected to menopause: dry eyes. And more often than not, other imbalances that affect the eye are also at work but only become evident when hormones begin to fluctuate.
Women are twice as likely as men to suffer from dry eyes; and for reasons scientists don't understand, Hispanic and Asian women are especially vulnerable.
Symptoms of dry eye
Temporary mild symptoms of tired, itchy, or red eyes that abate with sleep, a change in environment, or taking your contact lenses out can be chalked up to obvious culprits. But worsening or persistent symptoms should be taken seriously. They include:
- a scratchy or gritty feeling
- tears running down the cheeks
- increasingly tired eyes during the day
- irritation from smoke, wind, or air movement
- stringy mucus
- sensitivity to light
- problems wearing contact lenses
If dry eye is left untreated, the cornea can become scarred or develop ulcers. Infection can also become more common because eye fluids help carry away debris. Vision can be affected, and you may feel chronic eye pain. But getting to the real cause of the condition can take some sleuthing.
What causes dry eyes?
In dry eye syndrome, the lacrimal gland or associated glands near the eye don't produce enough tears, or the tears have a chemical composition that causes them to evaporate too quickly.
Dry eye syndrome has several causes. It occurs as a part of the natural aging process, especially during menopause; as a side effect of many medications, such as antihistamines, antidepressants, certain blood pressure medicines, Parkinson's medications and birth control pills; or because you live in a dry, dusty or windy climate.
If your home or office has air conditioning or a dry heating system, that too can dry out your eyes. Another cause is insufficient blinking, such as when you're staring at a computer screen all day.
Dry eyes also are a symptom of systemic diseases such as lupus, rheumatoid arthritis, ocular rosacea or Sjogren's syndrome (a triad of dry eyes, dry mouth and rheumatoid arthritis or lupus).
Long-term contact lens wear is another cause; in fact, dry eyes are the most common complaint among contact lens wearers. Recent research indicates that contact lens wear and dry eyes can be a vicious cycle. Dry eye syndrome makes contact lenses feel uncomfortable, and evaporation of moisture from contact lenses worsens dry eye symptoms.
Incomplete closure of the eyelids, eyelid disease and a deficiency of the tear-producing glands are other causes. Tears are composed of three layers:
- the outer, oily lipid layer;
- the middle, watery, lacrimal layer;
- and the inner, mucous or mucin layer.
Each layer is produced by different glands near the eye. The lacrimal gland located above the outer corner of the eye produces the lacrimal layer, for example. So a problem with any of those sources can result in dry eyes.
With increased popularity of cosmetic eyelid surgery (blepharoplasty) for improved appearance, dry eye complaints now occasionally are associated with incomplete closure of eyelids following such a procedure.
There are other ertain lifestyle factors that contribute to dry eyes include:
- Living and working in dry places. Dryness is usually worse in dry weather, in desert climates, during the winter, and when the eyes are exposed to second hand tobacco smoke or air pollution.
- Having LASIK surgery, which cuts eye nerves, reducing impulses for blinking. If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until the problem is resolved.
- Diets that don’t provide sufficient essential fatty acids or anti-inflammatory foods
Conventional medicine generally stops here when it comes to identifying the cause of dry eye, but the root imbalances that lead to many cases of dry eye extend much deeper, particularly for women in perimenopause and menopause. Often it’s just the tip of the iceberg. That’s because hormones play an important role in tear production and lubrication.
Hormonal changes and dry eyes
The degree to which your hormones affect your eye health depends largely on your individual blueprint and lifestyle. However, studies have linked androgen (testosterone) and estrogen receptors on the cornea of the eye and on the meibomian gland. This indicates a correlation between the production of tears and our sex hormones.
Before menopause, the more testosterone you have, the fewer tears you produce, while an increase in estrogen means more tear production. However, this equation reverses during menopause — more testosterone means more tear production, while more estrogen means less tear production. And while we still need to learn more about how this mechanism works, it’s clear that hormones play a significant role in lubricating our eyes. It makes sense that dry eyes may result from estrogen deficiency, progesterone deficiency, testosterone deficiency or possibly from an imbalance of any of the three.
When your eyes stay dry for too long, the result is localized inflammation. This immune response releases all kinds of inflammatory substances which make your eyes red, itchy, and swollen. The appearance of dry eyes often coincides with other signs of “drying” in menopause, like sore joints and dry vaginal tissues. Restoring a natural internal balance between estrogen, progesterone and testosterone is an important remedy for dry eyes.
Relief for dry eyes
Everybody is unique so you may need to experiment to find a combination of changes that work for you.
Optimize your nutrition. Eat three balanced meals a day, consisting of whole foods in any nutritional gaps with a daily multivitamin. Eat less meat, fried foods and dairy products and more chunky white tuna and walnuts.
Balance your hormones. Gentle endocrine support can help the body generate its natural levels of estrogen, progesterone and testosterone. You may also notices that some simple dietary changes, like eating more whole grains and less sugar and processed foods can help control insulin levels and reduce chronic inflammation.
Include flaxseed in your diet. Flaxseed is one of nature's best sources of n-3 essential fatty acids, which are the essential fatty acids the body uses to make anti-inflammatory hormones. Brazilian clinical researchers have found that flaxseed oil is an effective treatment for the condition of dry, red, inflamed eyes known as keratoconjunctivitis sicca. Brazilian women taking one or two 1,000-mg capsules of flaxseed oil every day for six months experienced a dramatic reduction in the redness and inflammation associated with dryness.
Evaluate your medications. If you are on medication, speak with your doctor about the possibility of it contributing to your dry eyes. Keep in mind that many medications required by adults over age 40 may cause or worsen dry eye problems. Examples include diuretics (often prescribed for heart conditions) and antidepressants. There may be suitable alternatives that cause fewer side effects.
Avoid excessive pollution and other irritants. Here’s another great reason to quit smoking: smoke aggravates dry eyes. Also, try to avoid rubbing your eyes since it can disturb tear film, remove moisture, and introduce bacteria or irritants into the eye. Try to buy hypoallergenic make-up as well.
Hydrate and humidify. Dehydration can draw fluid from the eyes, so remember to drink plenty of fluids. Non-diuretic drinks like water, pure juices, milk and herbal teas are good choices for hydration. You may also try using a humidifier to reduce tear evaporation, but be sure to clean it daily with soap to avoid introducing more irritants into the air.
Blink! Try to blink at least every five seconds or so, particularly when looking at your computer screen. It may also be helpful to lower your computer monitor a bit so your eyelids cover more of your eyeballs while you look at it.
Avoid unnecessary touching eyes. Too much rubbing may cause a loss of moisture and can promote bacteria growth in the eye.
Practice care with contact lenses. Contacts can sap the eye’s fluid and collect proteins, irritating eyes further with roughness and an environment conducive to growing bacteria. Keep lenses very clean, consider wearing them less, or explore lenses designed for dry eyes. Not all drops can be used with contacts, so check the labels.
Optimize your computer experience. Rearrange your computer screen so that you are looking down on the monitor.
Avoid (or at least reduce) eye make-up whenever it is possible. Some of the make-up brands might cause severe irritation and other negative health consequences.
Get more sleep! Last but definitely not least: enjoy the anti-inflammatory benefits of regular sleep! Beyond giving your eyes a chance to rest and refresh, good quality sleep reduces stress that can contribute to hormonal imbalances. Our bodies detoxify and attend to much needed cellular repair while we sleep, which helps soothe inflammation in all systems.
Note that all these recommendations may provide temporary relief or might be insufficient to improve the dry eyes conditions significantly. If your symptoms are severe, you should visit your eye care professional. There are prescription tears available that are longer lasting and more effective than over-the-counter alternatives. Your eye doctor may recommend inserting punctal plugs - special silicone plugs placed into the tear ducts, preventing tears from draining out. This allows tears to lubricate the surface longer. There is also surgery available that can help stimulate tear production in the eyes of older women.
Sources and Additional Information: