Women’s health articles
Seeing clearly about dry eyes and menopause
by Marcelle Pick, OB/GYN NP
What symptoms do you think of when it comes to menopause?
Hot flashes, insomnia, vaginal dryness, mood swings, fatigue, headaches —
all the usual suspects, right? Yet one symptom affects more than 60% of women and
they don’t even know it’s 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.
Eyes are the windows of the soul, it’s said. But in my experience they are
also windows into your physiology and can turn dry, itchy, red, and irritated in,
literally, the blink of an eye. Symptoms of dry eye are an invaluable warning that
something deeper is brewing in your system and needs to be looked at — a truth
many Eastern practitioners have known for millennia.
Yet conventional medicine continues to tell us that dry eye is an isolated condition,
one that is best served by covering up the symptoms with drops or blocking the eye’s
tear drainage system. At Women to Women, we’ve had tremendous success treating
dry eye from the inside out. So let’s take an up-close look at dry eye because
it can affect so many of us and learn how to restore balance to the body and the
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?
Dry eyes can develop for two reasons: insufficient oil production by the meibomian
glands (found in the inner eyelids) or too much evaporation of the eye’s watery
tears. Most people with dry eyes are affected by both low oil and high evaporation.
Symptoms of dry eye are also common with certain auto-immune disorders, like diabetes,
arthritis, lupus, and Sjögren’s syndrome.
If you think you may have dry eye, call your healthcare practitioner and schedule
a medical evaluation of your eyes. You will also be asked a number of questions
about your lifestyle and habits. Lifestyle factors that contribute to dry eyes include:
- Looking at computers or reading without blinking often enough to redistribute eye
- Living and working in dry places
- Wearing contact lenses that absorb eye fluids
- Having LASIK surgery, which cuts eye nerves, reducing impulses for blinking
- Taking medications like allergy pills, diuretics, beta-blockers, birth control pills
or other drugs that dry out the body
- Diets that don’t provide sufficient essential fatty acids or anti-inflammatory
- Droopy eyelids or certain health conditions, particularly autoimmune disorders like
diabetes, arthritis, lupus, and Sjögren’s syndrome, which also causes
dryness in the mouth.
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. Though this is something we rarely hear about
in a conventional eye doctor’s office, or other imbalances that may be contributing
to the condition. For a more profound look at dry eye, you need to look East.
An alternative view of dry eyes
In many Eastern healing traditions, the eyes are crucial diagnostic tools. During
an exam, practitioners peer intently into a patient’s eyes to gain insight
into the root of their health concerns. In Traditional Chinese Medicine (TCM), the
eyes are the organs through which your purest energy flows. When you are healthy
and balanced, your eyes emanate a clarity or awareness that is immediately visible
to the practitioner. And when you are imbalanced, it also shows in your eyes. Why?
Because the organ that rules the eye in TCM is the liver: the organ of detoxification.
As a holistic, functional medicine practitioner, I agree that symptoms of dry eye
can be an important warning sign that your body’s detox capabilities are on
overload. And what happens when you aren’t detoxifying efficiently?
Inflammation. While no clinically controlled study as of yet has linked
the localized inflammation of dry eye to systemic low-grade inflammation, my experience
with thousands of patients over the past 20 years has shown me that they are branches
off the same tree. An inner physiology that’s weighted toward fire will (figuratively)
drink up any available lubricants — including your eye fluid.
Moreover, the inflammation connection is being supported by the growing trend among
conventional eye doctors to add omega-3 supplements or fish oil to their standard
dry eye treatment protocol. A recent study reported that women with a diet rich
in omega-3 fatty acids reduced their risk of dry eye by 20% compared to women with
low levels of omega–3.
Increasing your intake of omega-3 fatty
acids — either in supplements or by eating fish like mackerel, tuna,
or wild salmon or certain nuts and seeds — does several things that benefit
the eye by benefiting your entire body. For one, they have been shown to naturally
moderate inflammation. They also aid in the stimulation of tear secretion and increase
the oils in that secretion. Additionally, they may moderate excess estrogen production.
And all of these benefits get at the root of dry eyes by providing natural lubrication
rather than temporary “artificial” relief.
Conventional dry eye treatments and “artificial tears”
The most common conventional treatment for dry eye is drops or “artificial
tears” that temporarily relieve symptoms by restoring fluid to the eye. These
drops can be invaluable in the short term for many people with dry eyes by making
it comfortable to blink. The unfortunate side of drops, though, is that they offer
only temporary relief of dry eye symptoms, not a systemic response that helps prevent
If your symptoms of dry eye are really bothering you, it’s worth finding some
soothing drops to use while you pursue other long-term approaches that may take
more time to kick in. The ingredients and viscosity of drops vary a lot, so you
may need to try a few; be sure to ask your practitioner for samples. When buying,
remember that preservatives irritate some eyes, and drops designed to “get
the red out” are not designed for dry eyes.
Keep in mind that using drops is like pouring water into a dry well instead of looking
for a new spring — to find permanent relief you need to start digging.
Relief for dry eyes: the Women to Women approach
At Women to Women, we’ve helped many women recover and prevent dry eyes by
building up their core foundation of nutrition and restoring their hormonal balance.
Every body is unique so you may need to experiment to find a combination of changes
that work for you. My experience at the practice has led me to believe that supplemental
essential fatty acids, in addition to a highly nutritious diet, are helpful for
women of all ages with dry eyes. So let’s start here:
Optimize your nutrition. Eat three balanced meals a day, consisting of
whole foods (for more information, see our
Nutritional and Lifestyle Guidelines). Fill in any nutritional gaps with
a daily multivitamin. Choose a formulation like the one in our Personal Program
that has a good balance of essential fatty acids, including EPA and DHA, plus vitamin
E, which helps the omega-3’s do their work. Keep in mind that you need the
right balance of omega-3’s, 6’s and 9’s — not more of everything.
Be sure your
is free of lead, mercury, PCB’s and other contaminants.
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.
(Take a look at our anti-inflammatory
diet suggestions for ideas.)
Evaluate your medications. If you are on medication, speak with your doctor
about the possibility of it contributing to your dry eyes. There may be 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.
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. TheraTears makes a product specifically designed for contact
wearers with dry eyes.
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.
Heed the insight of your third eye
In the end, your “third eye” — your intuition — may be one
of the best tools in helping you find ways to keep your eyes healthy and comfortable.
Start from the inside when looking for solutions. Know that dry eye is extremely
common during menopause and that you are not alone. Try to be patient as you wait
for improvement and talk with your healthcare practitioner if your condition worsens
or doesn’t improve. Eyesight is so much a part of our daily lives that most
of us take it for granted until something goes wrong. Consider making some positive
changes that will benefit your eyes — and the rest of you — for life.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements,
our exclusive endocrine support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
Related to this article:
References & further reading on
Last Modified Date: 04/19/2011
Principal Author: Marcelle Pick, OB/GYN NP