Guide · dry eye
Dry eyes and the menopause
Dry eyes are one of the commonest menopause symptoms and almost nobody mentions them — not the GP, not the leaflets. The hormones that change everything else change the oil glands in your eyelids too. It’s treatable.
Why it happens
The glands inside the eyelids that make the oil layer of your tears are sensitive to hormones — to androgens in particular, which fall through the menopause. Less oil, thicker oil, glands that block. The water evaporates, the eye dries, stings, waters in the wind and blurs by evening. It often starts in perimenopause, years before periods stop, which is why it’s rarely connected.
What HRT does
Helps some women’s eyes, makes no difference to others, and in some studies oestrogen alone slightly worsens dryness. It’s not a dry eye treatment. If you’re on it for other reasons, good; don’t start or stop it for your eyes.
What works
Treating the glands directly, which works whether or not you’re on HRT. The £15 gland scan photographs them. If they’re blocked, EyeClean clears them over three visits; a home routine keeps them clear. If the lids are also inflamed — common in this group — light treatment settles that. And where the water is short too, plugs or Lacrifill keep what you make on the eye.
Say it at the appointment
Tell us where you are with the menopause. It changes what we look for and what we recommend, and it’s a routine question here, not an awkward one.
The three types of dry eye, and what we do for each
Most people are told “you’ve got dry eyes” and handed drops. But there are three different causes, and each needs something different. Most people have a mix.
Blocked oil glands: meibomian gland dysfunction (MGD)
About 8 in 10 people with dry eye have this. Along the edge of each eyelid are about 30 tiny glands that put a thin layer of oil on your tears. When they block, your tears dry up in seconds, however much water your eyes make. It feels gritty, burning and tired, often worse on screens or by evening. Drops help for an hour, because they don’t unblock the glands.
What we do: photograph your glands so you can see them, warm and clear them in clinic, clean the lid edge, and use IPL or light therapy where it helps. Then we give you a simple routine for home.
Not enough tears
Your eyes don’t make enough of the watery part of tears. This is more common with age, some medicines, the menopause, and conditions like Sjögren’s.
What we do: measure your tear level, choose the right drops for you, and use tiny plugs to keep your own tears in where they help. We’ll write to your GP if something needs checking.
Inflamed eyelids: blepharitis, often with tiny mites called Demodex
Crusty, itchy, red lid edges, often worse in the morning.
What we do: deep-clean the lid edge in clinic, treat the mites, and show you how to keep the lids clean at home.
Not sure which one you have? That’s what the assessment is for. We look at your glands, tears and lids, and tell you which type, or which mix.
The short version
- Falling androgens change the oil glands in the lids; dry eye follows
- Often starts in perimenopause, so it’s rarely connected
- HRT isn’t an eye treatment either way
- The glands can be scanned and cleared whatever else is going on