Eye & Vision Changes

Hormonal changes during menopause can cause eye appearance and shape changes, inflammation and changed eyesight affecting vision. Eyesight refers to how well your eyes capture images, and vision refers to how your brain processes what the eyes see to understand and act on that information. There are estrogen receptors in the cornea, retina, and optic nerves in the eyes.

Eye changes can manifest as dry or watery eyes, eye curvature imperfection (astigmatism), floaters (muscae volitantes), and eyelid inflammation (blepharitis). As for vision, individuals may experience blurred vision, loss of central or peripheral vision, farsightedness (hyperopia), light sensitivity (photophobia), and nearsightedness (myopia).

Eye and vision changes can also occur at other times when hormones fluctuate, including during menstruation and pregnancy, while taking birth control and Hormone Replacement Therapy (HRT), and as part of the aging process. Other conditions that may emerge include glaucoma, cataracts, and age-related macular degeneration (AMD).

The reduction of estrogen and progesterone is a driving cause of eye and vision changes. Estrogen and progesterone influence eyes and vision, and reduced levels, as well as androgen, can affect the eye’s meibomian (oil) glands, that produce the oily layer of tear film, leading to dry eyes and epiphora (watery eyes) to compensate for the dryness. The hormonal reduction can also make the cornea, the outermost clear layer of the eye, involved in light refraction, less stiff with more elasticity and increased sensitivity, affecting how light travels into the eye, affecting focus, and resulting in blurred vision. This increased sensitivity can also make the eyes more susceptible to environmental irritants such as wind, smoke, and dust, as well as infections and inflammations like blepharitis.

Other impacts include changes in intraocular pressure, reduction in anti-inflammatory properties and reduction in collagen, all important in maintaining eye health. Hormonal changes can lead to inflammation, thinning, and change in structure from gel to liquid-like in the vitreous humor, the clear gel-like substance inside the eyeball behind the lens, making it more susceptible to degeneration, the formation of muscae volitantes, and more free movement of muscae volitantes, increasing noticeability.

Eye and vision changes typically settle post menopause, however, if issues continue or you experience sudden changes such as increased blurred vision, sudden increase in the number of floaters, or vision loss, consult with an ophthalmologist, specialist in eye and vision care, or other healthcare professional to rule out more serious medical conditions like diabetes or retinal detachment.

Menopause-related eye and vision changes encompass a diverse array of symptoms that can affect ocular health and visual acuity. These changes are often linked to hormonal fluctuations, particularly the decrease in estrogen levels, which can influence the health and functioning of the eyes. Common eye changes during this period include astigmatism, dry eyes, watery eyes (epiphora), and muscae volitantes, each presenting unique challenges to ocular comfort and health. Blepharitis can become more common, causing discomfort and potential vision disturbances.

Vision changes are also a significant concern, with many women experiencing symptoms such as blurred vision, central vision loss, hyperopia (farsightedness), myopia (nearsightedness), photophobia (sensitivity to light), peripheral vision loss, and presbyopia (age-related farsightedness). These vision changes can profoundly affect daily activities, requiring changes in lifestyle and possibly corrective measures. While eye infections are not very common during menopause, red and irritated eyes can result from ocular rosacea, a form of the skin condition rosacea on the eyes, which goes beyond facial flushing.

Understanding and addressing these symptoms is important for maintaining eye health and ensuring quality of life during the menopausal transition.

Eye Changes

Eye changes include astigmatism, dry eyes, epiphora, and muscae volitantes. During menopause, women may find wearing contact lenses becomes uncomfortable due to eye shape changes, or they need corrective lenses due to vision changes.

Astigmatism is a condition characterized by an irregularly shaped cornea, the clear protective tissue that covers the front of the eye, or the lens inside the eye, the clear structure that sits behind the iris. The iris is the colored part of the eye that surrounds the center opening called the pupil, which regulates the amount of light that enters the eye. The curved shape of the cornea becomes irregular, changing from a round to egg-shape. This change can increase risk of corneal abrasions or infections, and cause light to focus unevenly, resulting in distorted or blurred vision at all distances.

Dry eyes occur when tear glands produce insufficient tears, there is changed tear film composition, or there is not enough moisture in the eyes. This can lead to discomfort, itchiness, and redness, or a gritty, scratchy sensation, or feeling of a foreign body in the eye. These expressions are due to increased friction between the eyelid and the cornea. Symptoms can also include sensitivity to light, difficulty focusing and blurred vision. Certain medications can contribute to dry eyes, including acne medications, antidepressants, antihistamines, birth control, blood pressure medications, Parkinson’s disease medications, HRT, nasal decongestants, pain relievers, and sleeping pills. Dry eyes may progress or contribute to the development of dry eye syndrome, or chronic dry eye syndrome (also called Dry Eye Disease (DED) and Keratoconjunctivitis Sicca (KCS)), if left untreated.

Epiphora is characterized by an excessive production of tears, leading to a persistent overflow. Epiphora occurs in response to dry eyes as a compensatory mechanism to ease dryness. This symptom can affect daily activities, such as reading or driving, and can contribute to feelings of frustration or discomfort.

Muscae Volitantes are small pieces of debris floating in your vitreous humor, a clear gel-like substance inside the eyeball behind the lens. As you age, the vitreous liquifies and contracts, causing microscopic collagen fibers within it to clump together. These clumps cast tiny shadows on the retina, manifesting as floaters. They are typically small gray or black specks, spots, strings, threads, squiggly lines, cobweb-like strands, or clouds, floaters drift in your field of vision, moving as your eyes move and often drifting away when you try to look directly at them. You may notice floaters when you look at something bright, like a white wall or blue sky. Some woman notice floaters are exacerbated during menopause, likely due to age-related changes in the vitreous.

Eyelid Inflammation (Blepharitis)

Blepharitis is characterized by symptoms such as red, swollen eyelids, a gritty sensation in the eyes, and frequent blinking. Hormonal reductions during menopause can heighten susceptibility to blepharitis due to decreased eye moisture and poor oil production. Women may also experience itchy eyes, a burning sensation, excessive tearing, or dry eyes.

There are two types of blepharitis. The first, anterior blepharitis involves deposits building up on the eyelashes, often leading to bacterial infection and symptoms like itchiness or a burning sensation. The second, posterior blepharitis, or meibomian gland dysfunction (MGD), located at the back of the eyelid, the meibomian glands produce poor-quality oils, leading to blockages. This results in an insufficient oil layer on the cornea, increasing evaporation and contributing to dry eyes.

Blepharitis can be uncomfortable and may disrupt vision because of an unstable tear film. Persistent symptoms can irritate and may affect quality of life if not managed.

Vision Changes

Menopause-related vision changes include blurred vision, central vision loss, hyperopia, presbyopia, myopia, peripheral vision loss, and photophobia. They are often symptoms of other related conditions. Blurred vision, for example, is a symptom of dry eyes and age-related macular degeneration (AMD) which menopause can contribute to their development and progression. Blurred vision is characterized by a lack of sharpness, causing objects to appear hazy, distorted, or out of focus. Central vision loss manifests as a blind spot in the center of the visual field, and is also a symptom of AMD.

Hyperopia results in issues with close-up vision, as does age-related farsightedness (presbyopia). Myopia leads to difficulties in seeing distant objects clearly. Collectively, these changes are termed ametropia, along with astigmatism. This includes any refractive condition that does not allow for a properly focused image in view on the retina. When ametropia remains uncorrected, it can lead to vision impairment.

Photophobia causes discomfort, pain, or the need to squint when exposed to bright lights. Eye dryness can make the eyes more susceptible to irritation from bright lights.

While not directly related to menopause, peripheral vision loss, or tunnel vision, causing the loss of side or peripheral vision, can be caused by other conditions affecting your eyes, brain, blood vessels, and nerves. Some of these include glaucoma, diabetes-related retinopathy, migraine headaches, concussions, and high blood pressure (hypertension).

Diagnosing menopause-related eye and vision changes involves a detailed eye examination by an ophthalmologist, beginning with a review of your medical history. This step is important for identifying menopause-specific symptoms like dryness, redness, or blurred vision. The eye examination includes both external and internal assessments of the eyes to detect physical alterations, structural changes in the eyes, and related conditions.

Tests include visual acuity and refraction, which assesses the eyes’ focusing abilities and can reveal conditions like presbyopia (age-related farsightedness). Such tests are integral in determining the need for corrective lenses or other vision aids.

In certain cases, specialized tests such as optical coherence tomography may be performed for a more in-depth analysis of your eye’s structure and function. Similar ocular symptoms can occur because of other life stages, like pregnancy, or systemic diseases such as Sjögren Syndrome, endocrine (including thyroid) disorders, diabetes, and trachoma, so consultation with a healthcare professional is recommended to rule out other potential causes.

Treatment for menopause-related eye and vision changes involves a combination of medications, therapies, and dietary supplements. Where symptoms are related to an underlying cause, that condition requires treatment.

While HRT may help eye and vision symptoms by balancing hormone levels to maintain the tear film and ocular surface, it may increase the risk of ocular conditions such as cataracts, and some women experience increased symptoms such as dry eye. Artificial tears, ointments and anti-inflammatory agents can help manage dry and watery eyes, polymers, gels, and solutions can restore the quality and quantity of tears, eyelid scrubs, and antibiotic ointments can treat blepharitis, and a range of eye drops can provide relief for vision changes, such as myopia and presbyopia.

Sometimes, surgical procedures may be necessary, such as a vitrectomy, where small openings are made in your eye wall to remove vitreous humor (a clear gel-like substance inside the eyeball behind the lens) from your eye with a suction tool. The procedure can be performed for chronic eye floaters that interfere with daily functioning, as well as retinal detachment and diabetic retinopathy, with more steps to re-attach or repair the retina.

Other procedures include the insertion of punctual plugs, or tear duct plugs, for dry eyes to conserve tear volume. If unsuccessful, punctual cauterization may be performed where the tear duct is permanently closed, preventing tears from draining out of the eyes. Where corrective lenses, readers, and anti-reflective coatings on glasses are unsuccessful, refractive surgery like Laser-Assisted In Situ Keratomileusis (LASIK), which can correct the shape of the cornea, may be performed for myopia, presbyopia, hyperopia, and astigmatism, different to cataract surgery which replaces the lens behind the iris.

Natural therapies, such as light therapy, can help treat dry eyes by reducing inflammation and treating meibomian (oil) gland dysfunction (one of the causes), when treatments like drops are unsuccessful.

Dietary supplements, such as antioxidants, including Lutein and Zeaxanthin, carotenoids in the retina and lens, help filter blue light, maintain healthy eye cells, and reduce glare sensitivity. Omega-3 fatty acids, found in fish oil supplements, can help improve dry eyes and tear quality. Phytoestrogens, plant-based compounds that mimic estrogen in the body, can be an alternative to HRT.

The effectiveness of these treatments varies among individuals and should be discussed with a healthcare professional.

Menopause-related eye and vision changes can be managed through lifestyle modifications and a preventive and protective approach to ocular health.

Mind-body exercises like yoga and Tai Chi and mindfulness practices like meditation and deep breathing can help manage stress, which is a trigger for inflammation in the eyes, leading to increased dryness, irritation, and redness. Behavioral changes like getting your eyes tested regularly by an optometrist (a healthcare professional specializing in eye care), wearing wraparound sunglasses with ultraviolet (UV) protection, using disposable contact lenses or limiting contact lens use, keeping eyes moist with drops, using a warm compress or gel eye mask, reducing exposure to pollutants and drafts, increasing air moisture with a humidifier, and removing makeup at the end of the day, can all help prevent, protect and manage eye and vision symptoms.

A nutritious diet rich in Omega-3 fatty acids, zinc, and antioxidants like lutein, zeaxanthin, vitamins A, B12 (cobalamin), C, D (ergocalciferol (D2) and cholecalciferol (D3)), E, and K can support ocular health. Food options include salmon, shellfish, eggs, and red meat, including organ meat like liver. Staying hydrated with purified water can help maintain eye moisture and reduce dryness.

Regular physical exercise and activity help manage weight, reduce stress hormones, such as adrenaline and cortisol, and increase blood flow in the body, including the eyes. Exercise can help improve sleep quality and reduce disrupted sleep, which can affect the eyes, leading to blurred vision, dryness, and redness. Sleep hygiene practices like maintaining a regular sleep schedule, limiting exposure to blue light from electronic devices, particularly before bed, reducing caffeine in the afternoon and night, and creating an ideal sleep environment can help manage disrupted sleep and protect your eyes.

Maintaining social connections, engaging in stimulating activities, and taking part in enjoyable activities can help reduce stress levels supporting eye health. Reducing smoking can help reduce eye irritation. Managing conditions such as diabetes and high blood pressure support ideal eye health, and helps reduce the risk of other eye conditions.

Eye and vision changes during menopause result from a reduction in estrogen and progesterone, leading to a range of ocular symptoms such as dryness, watery eyes, inflammation, floaters, and vision changes. Diagnosis necessitates a thorough examination to differentiate symptoms from other conditions such as diabetes. Treatment strategies vary based on specific symptoms and may include topical eye solutions, therapies such as light therapy, and surgical interventions. Management strategies include regular eye examinations. Protective measures, such as wearing sunglasses and reducing exposure to environmental irritants, play a key role. Stress management and good sleep hygiene are essential in mitigating the impact of ocular symptoms. Adopting a holistic approach that includes preventive care, appropriate treatment, and lifestyle adaptations can ease ocular challenges, enhancing overall quality of life.