eye changes in perimenopause

Eye Changes in Perimenopause

Have you become very aware of your eyes? Do they often feel dry and scratchy? Maybe itchy? More sensitive? Like they’re overexposed to the elements? Has it become really hard to keep your contact lenses in for longer than an hour? If you can wear them at all.

Wondering why? It could be perimenopause.

Perimenopause can start as early as 35 and often before you notice changes to your period. During this transitional phase leading up to menopause hormonal fluctuations are common and can have varied and unexpected effects on your body, including your eyes. These hormonal changes can lead to dryness, discomfort, and alterations in your vision, potentially impacting your daily activities.

Understanding Eye Changes in Perimenopause

Understanding eye changes in perimenopause is important as they can be both surprising and challenging. It’s not uncommon to experience symptoms like your eyes feeling gritty or sensitive to light, or finding yourself straining to read in dim light. While aging is a natural part of life, and vision often declines with age, the hormone shifts in perimenopause can exacerbate or accelerate these changes.

Knowledge of how perimenopause can affect your eyes can prepare you to take proactive measures. For instance, Dry eye syndrome is a noticeable condition that can occur during this life stage, presenting challenges that range from mildly annoying to significantly disruptive. By recognizing these potential changes early, you can seek appropriate eye care and minimize the impact on your daily life. Adequate management and regular check-ups become increasingly important to maintain your eye health through perimenopause and beyond.

Hormonal Fluctuations and Eye Health

During perimenopause, your body undergoes substantial hormonal changes, notably in estrogen levels. Estrogen plays a key role in maintaining the health of various tissues, including those in the eye. Fluctuations in estrogen, as well as other sex hormones, may increase your risk of developing certain eye conditions including:

Dry eyes: This condition can lead to discomfort due to insufficient or poor-quality tears maintaining eye lubrication. A decrease in estrogen and androgens can cause a decrease in the oil production required to keep eyes properly lubricated. Changes to the tear ducts can also occur as estrogen declines resulting in insufficient tear production.

Issues with contact lenses: Dry eyes can make wearing contact lenses challenging. The lenses tend to make the gritty sensation of dry eyes worse. You may also find out that your contact lenses no longer fit properly as declining estrogen can change the shape and thickness of your cornea. Blurred vision vision can happen in addition to the discomfort.

Itchy eyes: Declining estrogen can lead to inflammation. And without proper tears, the eyelid opening and closing can cause friction on the eye surface. You may also experience an increased sensitivity to things like wind, dust and smoke. All of which can make for some very itchy eyes.

Red, swollen eyelids: Also knows as blepharitis, this type of inflammation impacts the areas where the eyelashes grow making them red and swollen, often with flaking skin. This condition can also cause a gritty sensation in your eyes. Dropping estrogen is again the main culprit making your eyes more susceptible to inflammation and infections.

Watery eyes: The body’s response to dry eyes and increased eye sensitivity is to produce more tears. But because your tears now lack the oil needed to produce quality tears, they evaporate quickly. Leading to more tears, and boom, your eyes are watering all the time.

Light sensitivity: When your eyes become dry, they also become more sensitive to light. You may find yourself squinting a lot more due to a new discomfort associated with bright light.

Trouble seeing at night: Declining estrogen can impact the health of your retina, the part of your eye that allows you to see in dim light. Your changing hormones can also impact the production of the pigment that helps with night vision. If you are finding it harder to see in dimly lit environments, your hormones could be at play.

Managing Eye Health in Perimenopause

Perimenopause can lead to various eye health issues, such as dry eyes, changes in vision, and discomfort. Understanding how to manage these changes is important for maintaining your eye health during this transitional period.

Lifestyle and Dietary Considerations

Dryness and discomfort, often reported during perimenopause, can be exacerbated by lifestyle factors. To alleviate dry eyes, consider using a humidifier in your home to add moisture to the air.

Smoking can aggravate dry eyes, so quitting smoking is an important step you can take for the health of your eyes and overall well-being.

Diet plays a significant role in maintaining eye health. Increase your intake of omega-3 fatty acids, found in fish like salmon and flaxseeds. These fats can help improve tear production and quality, addressing issues with dryness. Remember to keep your body hydrated with plenty of water, as systemic hydration is vital for maintaining overall eye health.

As with all things health, getting enough sleep and managing stress is really important. Tiredness will exacerbate all of the symptoms listed above and chronic sleep deprivation can increase your risk of more serious eye conditions. Stress triggers inflammation in the body, including in the eyes, making all of the symptoms above worse.

Screen Time

Your screen time on computers and digital devices can contribute significantly to tired eyes and discomfort. To address screen time, it’s recommended to follow the 20-20-20 rule: every 20 minutes, shift your eyes to look at an object at least 20 feet away for 20 seconds. This can help maintain eye tissue elasticity and reduce strain. Additionally, using eye drops can alleviate dryness caused by reduced blink rates during prolonged screen exposure.

When To See Your Optometrist

If you are struggling with eyes changes in perimenopause, see your optometrist. Consulting with an optometrist can provide personalized advice tailored to your symptoms, such as red eye or fluctuating vision, which are not uncommon during perimenopause. They may recommend specific medications or eye drops to enhance tear production or address corneal health. If you wear contact lenses, perimenopause may require a change in the type, frequency, or care of the lenses to ensure adequate comfort and reduce the risk of dry eyes.

Declining estrogen can increase your risk of conditions like cataracts and glaucoma. Making it that much more important to have regular eye exams to monitor for any changes. Experts recommend a comprehensive eye exam at least every two years.

In cases where conditions like dry eyes become severe, your optometrist may refer you to an ophthalmologist. Treatments like the insertion of punctal plugs to help tears stay on the surface of your eyes longer are an example of interventions that require a specialist.

Regular visits to your eye care professional are not just about adjusting your prescription; they are a crucial part of your comprehensive health routine during perimenopause.

What About Hormone Therapy?

Can menopausal hormone therapy (MHT), also known as hormone replacement therapy (HRT) help with conditions like dry eyes? What about androgen treatments like testosterone eye drops? Studies show mixed results for hormone therapy as treatment for dry eyes. Some studies have shown that hormone therapy is beneficial, while others have shown no difference when compared to the control group. And some studies have demonstrated that hormone therapy for dry eyes can make the problem worse. More research is needed.


The intent of this information is to provide the reader with knowledge to support more efficient and effective communication with their medical providers. This information is not intended as medical advice.