Dry eyes during the menopause: causes, symptoms and help

Figure 1: Many women suffer from dry eyes during and after the menopause. The main reason for ocular dryness is hormonal changes that affect the tear film.

Many women experience dry, burning and itchy eyes during and after the menopause. The hormonal changes during the climacteric affect, among other things, the eye’s tear film, which often leads to dry eyes – the so‑called sicca syndrome. In this blog post we explain the link between the menopause and dry eyes and discuss which factors favour the development of the sicca syndrome. You will also learn how Traditional Chinese Medicine (TCM) interprets the phenomenon and receive six tips for preventing dry eyes during the menopause.

Menopause and dry eyes often occur together

Figure 2: Ocular dryness during the climacteric is not uncommon – around two thirds of women in the menopause are affected.

The menopause (medical: climacteric) is a phase of natural hormonal change for women. The transition begins years before the final menstrual period – the menopause – which on average occurs at around 51 years of age. During the menopause, which typically lasts five to ten years, the ovaries gradually reduce production of the female sex hormones oestrogen and progesterone. This process is often accompanied by well‑known menopausal symptoms such as hot flushes, night sweats, sleep disturbances or weight gain.

Dry eyes in the menopause are discussed comparatively little, even though they are quite common. According to a Spanish study, about two thirds of women in the menopause struggle with dry eyes. Particularly at the beginning of the climacteric the “sicca syndrome”, as dry eye disease is also known in technical jargon, often occurs. Dry eyes thus provide a clear example of sex‑specific differences in medicine: while women commonly experience ocular symptoms earlier as a result of the hormonal changes in the menopause, men are generally affected later and usually show a milder form of the sicca syndrome.

What happens in the eye when it becomes dry?

To understand how dry eyes develop, it is helpful first to look more closely at a healthy eye. A healthy eye continuously produces tears that keep the cornea and conjunctiva moist, defend against pathogens and supply nutrients to the cornea. The tear film consists of three layers. The first layer, which lies directly on the cornea, is the mucin layer, which ensures an even distribution of the tear fluid. This is followed by an aqueous layer, which is responsible for hydrating the eye and contains defence substances that combat pathogens entering the eye. The third layer is a lipid layer that prevents evaporation of the tear film.

The hormonal changes during the menopause can affect all three layers of the tear film. If the mucin layer and the aqueous layer are impaired, the tear film can no longer spread evenly over the ocular surface – the eye becomes dry.

Typical symptoms of the sicca syndrome include:

• burning, itching and redness
• a foreign‑body sensation (“sand in the eye”)
• watering eyes
• blurred vision
• light sensitivity

That the eyes may water more despite being dry may at first seem paradoxical. Often the reason is a changed composition of the tear film due to hormonal changes. If the tear film does not contain sufficient lipids, tears can no longer be retained on the eye and flow away freely. If nothing is done about dry eyes, the long‑term risk of inflammation of the eye and of damage to the cornea and conjunctiva increases. A reduction in visual acuity and further visual disturbances are also possible consequences of a chronic sicca syndrome.

The main reasons for dry eyes during the menopause

Figure 3: In addition to a decline in key sex hormones, nutrient deficiencies and lifestyle factors can contribute to the development of dry eyes.

Hormonal changes during the climacteric are the most common reason many women experience dry eyes in this phase of life. However, there are several other physiological aspects and lifestyle factors that can favour the sicca syndrome.

1. Hormonal changes

Normally oestrogen stimulates the tear and salivary glands. When oestrogen levels fall during the menopause, this not only leads to reduced tear production and lower quality of the tear film, but also to drying of the mucous membranes. Affected mucous membranes include the intimate area, the oral mucosa, the nasal mucosa – and the conjunctiva and cornea of the eye. The sensation of dryness can be further intensified by fluctuations and a later decline in the hormone progesterone.

Male sex hormones, so‑called androgens, which are also produced in the ovaries, play a key role as well. For example, testosterone is central to the function of the Meibomian glands that produce the oily protective layer of the tear film. When androgens decline, the tear film evaporates more quickly and becomes unstable. A lack of tears often leads to inflammation of the ocular surface and corneal damage that can impair vision.

2. Nutritional deficiencies affecting the cornea

Although they are rarely the sole cause of dry eyes in the menopause, nutritional deficiencies can significantly weaken the cornea and the tear film. Vitamin A is particularly important, as it supports both production of the mucin layer of the tear film and renewal of corneal epithelial cells. In addition, omega‑3 fatty acids, vitamin D, zinc, iron and B vitamins are among the nutrients that should be present in sufficient amounts in the body to help prevent dry eyes. A lack of nutrients can also weaken the eye’s immune defence, leaving the cornea less well protected against pathogens.

3. Favouring lifestyle circumstances

There are circumstances that promote ocular dryness in all life stages – not only during the menopause. Most people nowadays spend the majority of their time indoors. If the air is very dry due to heating or air conditioning, this can further irritate the eyes. Contact lenses can also sometimes promote dry eyes. Intensive screen work is another risk factor, because people blink less often and maintain a constant viewing distance for prolonged periods. As a result, the tear film is no longer regularly spread across the cornea, causing the eyes to dry out quickly.

What does TCM say about dry eyes in the menopause?

From the perspective of Traditional Chinese Medicine (TCM), the sicca syndrome is not an isolated eye problem but an expression of a deeper disharmony that typically occurs during the menopause. A kidney‑yin deficiency is often the focus.

In TCM the kidney is regarded as the root of life essence (Jing), responsible for strength, fertility and stability. It has two complementary poles: kidney‑yin and kidney‑yang. While kidney‑yang has an activating and warming effect, kidney‑yin has a cooling, nourishing and moistening function. A deficiency of kidney‑yin therefore often manifests in symptoms of dryness. Possible physical signs include dry skin, increased irritability, sleep disturbances, hair loss, hot flushes, night sweats – and also dry eyes.

Since yin energy naturally declines with age according to TCM understanding, a holistic therapeutic approach to strengthen yin is recommended for women in the menopause. This can include acupuncture and targeted stress reduction as well as an adapted diet rich in cooling and moistening foods (e.g. pears, berries, cooked green leafy vegetables, black sesame, millet).

Does hormone replacement therapy help the sicca syndrome?

Conventional medicine often recommends hormone replacement therapy (HRT = “Hormone Replacement Therapy”) to women in the menopause. The aim of treatment is to compensate for the decline of the female sex hormones oestrogen and progesterone and thereby alleviate typical menopausal complaints, which include the sicca syndrome. HRT can be given orally (e.g. tablets), transdermally (e.g. patches, gel) or vaginally (e.g. cream, pessaries, rings).

However, the decision to use hormone replacement therapy should always be carefully weighed and made only after consultation with a doctor. HRT is not without side effects and can be associated with an increased risk of blood clots, breast cancer and cardiovascular problems. Studies also show that the symptoms of the sicca syndrome can sometimes be worsened by hormone replacement therapy. Several other medications are also associated with potential worsening of dry eyes (e.g. antihypertensives, antidepressants, chemotherapeutics).

6 tips to prevent dry eyes during the menopause

Figure 4: Dryness of the eyes can be alleviated or prevented by certain measures – including eye care, eye exercises and nutrition.

Dry, burning and irritated eyes can hugely impair vision and quality of life. The good news is: you can do a lot yourself to prevent dry eyes or relieve existing symptoms. However, severe and persistent ocular dryness should always be examined by an ophthalmologist to rule out serious causes. The following tips are not aimed exclusively at women in the menopause, but are suitable for anyone who wants to support their eyes and counteract dry eyes.

1. Use eye drops and ointments: So‑called “artificial tears” can be used to moisten the eyes. It is advisable to choose a preservative‑free product. In addition, you can use eye ointments at night that support prolonged moisturising of the eyes during sleep.
2. Prioritise regular lid‑margin care: Consistent care of the lid margins promotes the function of the Meibomian glands that produce the oily components of the tear film. Place warm, moist wipes or cotton pads soaked in warm water on the closed eyes for about five minutes. Then gently stroke any thickened secretions towards the lid margin with a cotton bud. Warm compresses can support gland activity, regulate meibum production and help dissolve possible blockages in the Meibomian glands through heat.
3. Ensure a comfortable indoor climate: Dry indoor air can worsen existing eye complaints. Humidifiers or hanging damp towels can help by increasing humidity. Also try to avoid draughts, air conditioning and smoky rooms as much as possible.
4. Let your gaze wander: Especially during prolonged screen work, give your eyes conscious breaks. Look regularly out of the window or combine the break with a walk in the fresh air. During screen work, rapid blinking for about a minute can help to moisten and relieve the eyes. Simple eye exercises such as slow eye circles can also help relax the eye muscles and improve circulation.
5. Eat for eye health and drink enough: To form a stable tear film the body needs sufficient fluids. Drink at least 2 litres of water or unsweetened tea per day. In addition, pay attention to an eye‑healthy diet: omega‑3 and omega‑6 fatty acids (e.g. in sea fish such as salmon or mackerel) and high‑quality plant oils (e.g. linseed oil) have been shown in several randomised clinical trials to contribute to a subjective improvement of dry eye symptoms. Also include green leafy vegetables (e.g. spinach, kale, chard), colourful vegetables (e.g. carrots, pumpkin) and antioxidant‑rich foods (e.g. berries) more often in your diet.
6. Protect your eyes from wind and sun: Wearing a well‑fitting pair of sunglasses with UV protection shields your eyes outdoors. Sunglasses not only protect against harmful UV radiation but also against wind, which can accelerate evaporation of the tear film.

Disclaimer

This article does not replace treatment by a qualified practitioner. The basis of this article is studies and current literature. It must not be used for self‑diagnosis or self‑treatment. Discuss any ideas from this article with a practitioner you trust if necessary.

Biographical

Katharina Korbach regularly writes blog posts about medicinal plants and natural active ingredients for the Narayana Verlag. She developed an interest in language early on and began writing her own literary texts. A serious illness during her final school years prompted an intensive engagement with health and nutrition topics that continues to this day. After repeated failure of conventional medical treatments, she opted for a more self‑effective naturopathic treatment approach. A plant‑based diet was a key element of her healing journey.

Katharina studied Cultural Studies (B.A.) and Applied Literary Studies (M.A.). In 2022 she published her debut novel "Sperling" with Berlin Verlag. She now lives in Berlin as a freelance author, medical editor and lecturer. In her free time she most enjoys spending time with friends or attending barre training. She also loves travelling and trying out new vegan recipes.

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05.03.2026