To paraphrase Jane Austen, it is a truth universally acknowledged that a woman approaching midlife will experience physical changes that will take her by surprise. Take, for example, dry eyes. Turns out, this chronic eye condition is highly common among women in perimenopause and beyond.

Hilda Hernandez Nash says her symptoms sprung up earlier this year, as she was driving to work one morning. “All of a sudden I couldn’t tolerate my contacts,” she recalls. “My eyes just felt like they were sandpaper.”

Within days, her eyes became red, watery and swollen. At one point, she says, her eyes had trouble focusing. “I just didn’t want to open my eyes. I couldn’t tolerate the light.”

At first, Hernandez Nash, who is in her late 40s, thought she might have some form of pink eye. But when she saw an eye doctor, she learned her symptoms all pointed to dry eyes. Research suggests around half of all women in the menopausal transition years experience symptoms. 

“Dry eye is incredibly common,” says Lauren Gormley, an optometrist and assistant professor of ophthalmology with the Wilmer Eye Institute at Johns Hopkins University School of Medicine. While men get dry eyes too, “large-scale studies have shown that the rate of dry eye in women over 50 is double the rate of dry eye in men over 50.” And the prevalence increases with age.

The role of hormones

Gormley says the condition occurs when your eyes can’t produce enough tears or they dry up too quickly. And one of the most common causes is a problem with the meibomian glands, the oil glands in the eyelids that keep tears from drying up too fast.

“The oil can be ineffective, the oil volume can be too low, the oil could be too thick, or the oil could not be able to be released into the tear film,” Gormley says. “And that is where the connection comes into menopause.”

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She says that’s because sex hormones – in particular androgens – help regulate oil production in these glands. As androgen levels decline with age and menopause, the oil glands in eyes produce less and lower quality oil, “which then leads to faster evaporation of the tears and then increased inflammation of the ocular surface, which is really what dry eye is,” Gormley says.

The lacrimal glands, which produce the watery part of tears, contain estrogen receptors, and it’s likely that shifts in estrogen levels also play a role in dry eyes in women, although there is still a lot we don’t know, says Dr. Kelly Nichols, dean of the School of Optometry at the University of Alabama at Birmingham.