Eye Health During Perimenopause: What Changes and How to Manage Them
Perimenopause can affect vision, eye moisture, and ocular health in ways that often go unrecognised. This guide covers the key changes and practical management steps.
The Connection Between Hormones and Eye Health
The eyes are not immune to the hormonal changes of perimenopause, yet eye symptoms during this transition are rarely discussed or attributed to their hormonal cause. Oestrogen and progesterone receptors are found in the tissues of the eye, including the tear glands, cornea, and lens, meaning these structures are directly responsive to fluctuating hormone levels. As oestrogen and progesterone change during perimenopause, multiple aspects of ocular function can shift. The most widely recognised of these is dry eye, but visual acuity, the clarity of vision, can also change, as can intraocular pressure and the eye's sensitivity to light and contrast. Understanding the hormonal basis of these changes helps women make sense of symptoms that might otherwise seem unrelated to perimenopause and supports informed conversations with optometrists and doctors.
Dry Eye: The Most Common Ocular Symptom
Dry eye syndrome is significantly more prevalent in women than in men, and the risk increases during perimenopause and after menopause. The lacrimal glands, which produce the aqueous layer of the tear film, and the meibomian glands, which produce the oily layer that prevents tear evaporation, are both influenced by sex hormones. As oestrogen declines, tear film stability decreases and evaporation increases, leading to the symptoms of dry eye: burning, stinging, grittiness, transient blurring, and paradoxically, episodes of excessive tearing as the eye tries to compensate. Screen use, air-conditioned environments, contact lens wear, and antihistamines all worsen dry eye, and women in perimenopause may find that their tolerance for these previously manageable factors decreases. Lubricating eye drops used regularly can provide significant relief.
Vision Changes and the Need for Updated Prescriptions
Many women notice that their vision changes during perimenopause in ways that cannot be explained by age-related presbyopia alone. Corneal curvature, which determines how light is focused on the retina, can shift with hormonal fluctuations, causing prescription contact lenses or glasses to feel less accurate than they previously did. Some women find their near vision deteriorates more rapidly during perimenopause than in the years before. Others notice that their vision fluctuates slightly across their cycle or with hormonal changes, being clearer on some days and blurrier on others. If you have noticed any of these changes, it is worth mentioning them to your optometrist in the context of perimenopause, since it may affect the timing of prescription updates and whether your optometrist checks for dry eye as a contributing factor.
Intraocular Pressure and Glaucoma Risk
Oestrogen has a modest protective effect on intraocular pressure, the pressure within the eye. As oestrogen declines in perimenopause and beyond, intraocular pressure can increase slightly, which is one reason why the risk of glaucoma, a condition characterised by optic nerve damage often associated with elevated eye pressure, increases in postmenopausal women. This is not a reason for alarm in the majority of women, but it reinforces the importance of regular eye examinations that include intraocular pressure measurement. In the United Kingdom, NHS eye tests are free for people with a family history of glaucoma, those over forty with a direct family member with the condition, and over the age of sixty for everyone. Women in perimenopause with a family history of glaucoma should ensure they are receiving regular screening.
Contact Lens Comfort and Perimenopause
Women who wear contact lenses often find that their comfort and wearing time decreases during perimenopause, even with lenses they have worn successfully for years. The primary reason is dry eye, since reduced tear film quality makes lens wear less comfortable and may cause lenses to feel gritty, cause redness, or blur vision intermittently. Switching to daily disposable lenses can help, since deposit build-up on lenses worsens dry eye symptoms and daily lenses eliminate this factor. Using lubricating drops compatible with contact lens wear before and during wearing can extend comfortable wearing time. If contact lens discomfort becomes a persistent problem, a contact lens optician can assess the fit and material and may recommend silicone hydrogel lenses, which allow more oxygen to reach the cornea and tend to perform better in dry eye conditions.
Protective Habits for Eye Health in Perimenopause
Several habits directly support eye health during perimenopause. Wearing good quality sunglasses with UV400 protection when outdoors protects against UV-related damage to the lens, which can accelerate cataract development. Staying well hydrated supports tear film production, and dehydration worsens dry eye. Omega-3 fatty acids from oily fish, flaxseeds, or supplements have the strongest nutritional evidence for improving meibomian gland function and dry eye symptoms. The twenty-twenty-twenty rule, which involves looking at something twenty feet away for twenty seconds every twenty minutes of screen use, reduces digital eye strain. Ensuring that reading or screen environments are well lit without glare reduces the effort the eye has to make to focus and can decrease headaches and fatigue related to eye strain.
When to See Your Optometrist
Women in perimenopause should aim for at least a two-yearly eye examination, and more frequently if they have dry eye symptoms, wear contact lenses, have a family history of glaucoma, or have noticed recent changes in their vision. Symptoms that warrant prompt rather than routine assessment include sudden changes in vision, flashes of light, new floaters, a curtain or shadow across part of your visual field, or eye pain. These can indicate retinal or optic nerve issues that require urgent evaluation. It is also worth being explicit with your optometrist about being in perimenopause, since this context may influence decisions about intraocular pressure monitoring, dry eye assessment, and the frequency of follow-up. Most women find that optometrists are receptive to this information and that it improves the relevance of the care they receive.
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