It is common for women going through the menopause to experience dry eye symptoms. Changes in hormone levels can affect all three layers of the tear film, reducing the quantity and quality of your tears and increasing the risk of evaporation.
A drop in oestrogen levels can make skin thinner and less elastic, while mucus membranes dry out. The lacrimal glands produce less fluid. A decrease in androgen hormone affects the meibomian gland in the eyelids, which produce essential oils for the tears.
Research has found that 86% of women were unaware of the connection between the menopause and eye health. It is estimated that a third of the entire UK female population are currently perimenopausal or menopausal. The number of women aged 45 and older, which is when the menopause usually happens, is also on an upwards trend.
Research has also indicated that the majority of women experiencing the menopause suffer from dry eyes. The research indicates an association with changes in your hormones affecting how your tear film is made up and dry eye.
Dry eye can be seen as something of a hidden symptom of the menopause, so it is good to raise awareness of it both for patients and in the profession because we can really help our patients.
Put patients at ease
Dry eye can leave your eyes inflamed and looking red. Some patients report a gritty feeling to the extent of having the sensation of having a foreign body in their eyes.
Other patients say that their eyes are watering and streaming all the time because of dry eye. This is because the tears being produced are breaking up and falling out of their eyes. I have also had patients who suffer from glare. If left untreated, dry eye can cause severe discomfort and pain as well as infection.
There are studies that show more than a quarter of patients with dry eye experience anxiety or depression. I have seen that in clinics with patients because unfortunately the situation has become so acute that it really affects their lives.
Some patients I have seen have such debilitating symptoms that they choose not to drive at night. Living in the north of Scotland, that means they are not driving beyond 3.30pm in the winter when it is dark. It really can be that serious.
Clinicians should be compassionate and understanding, asking for a full medical history and history of symptoms. They should put the patient at ease and reassure them that there is help available. With a good management plan, their lives can be changed.
Clinicians also need to explain how important it is to stick to a long-term management plan because dry eye is a chronic condition. It is important to look at their lives in the round and be realistic about when, for example, they can apply drops to their eyes.
Practical advice
I suffer from dry eye myself, so can talk to patients with compassion. If they need eye drops, I often say that leaving your drops by your toothbrush at home and on your desk at work is a good idea because then you will have at least two lots of drops for dry eye a day.
Of course, individual plans may vary and it is important to explain this to the patient as well. Using preservative-free eye drops are usually the best option.
Patients need to be advised to have regular eyes tests and not to wait until their symptoms have become acute. The clinician needs to explain that they need to come back sooner in such circumstances. Being open with the optometrist is also important, even if they are not receiving treatment or seeing a GP for the menopause, because it can influence any management plan.
Staying hydrated, resting your eyes from screen time and having a good diet can alleviate symptoms. Another option is to use a hot compress or heated mask on closed eyelids, which can help soften and loosen any blocked oil glands that supply oil into the tears. But again the patient’s optometrist can advise on the most appropriate treatment.
If your patient is struggling with the mental health impact of dry eye syndrome, clinicians should recommend they speak to their family, or friends or seek professional help as they will be able to offer
support.
- Maria McAllister is part of the clinical performance consultant team at Specsavers.