Perimenopause and Eye Health: Dry Eyes, Vision Changes, and What to Do
Perimenopause can cause dry eyes, blurry vision, and other eye changes. This guide explains the hormonal link and how to protect your eye health during the transition.
Why Perimenopause Affects Your Eyes
Many women going through perimenopause report changes in their eyes and vision that seem unrelated to the hormonal transition. Sudden dry, gritty eyes. Blurry vision that fluctuates through the day. Contact lenses that no longer feel comfortable after years of wear. Increased sensitivity to light or screens.
These changes are not coincidental. Estrogen and androgen receptors are present in the lacrimal glands (which produce tears), the meibomian glands (which produce the oily layer that keeps tears from evaporating), and the corneal tissue itself. As hormones shift during perimenopause, these structures are directly affected. Eye health during the menopause transition is an increasingly recognized area of research, and women deserve clear information about what to expect and when to seek help.
Dry Eye Syndrome: The Most Common Perimenopause Eye Complaint
Dry eye syndrome occurs when the eyes do not produce enough tears, or when the composition of tears is poor and they evaporate too quickly. Both mechanisms become more common during perimenopause.
Estrogen influences tear production in complex ways. More clearly understood is the role of androgens (including testosterone, which declines in perimenopause) in supporting the meibomian glands. These glands line the eyelids and secrete the oily outer layer of the tear film. When androgen levels fall, meibomian gland function often decreases, leading to an unstable tear film that evaporates faster than it should.
Symptoms of dry eye include a burning or stinging sensation, the feeling of grit or a foreign body in the eye, intermittent blurry vision that clears with blinking, excessive watering (a reflex response to dryness), and discomfort with prolonged screen use or reading. These symptoms are often worse in low humidity environments, in air conditioning or heating, on airplanes, and in windy conditions.
If you are spending hours each day on screens, dry eye symptoms tend to worsen because screen use reduces your blink rate, allowing more evaporation between blinks.
Vision Changes and the Hormonal Link
Fluctuating estrogen affects the cornea, which is the clear dome at the front of the eye that bends light as it enters. The cornea contains estrogen receptors and its curvature and hydration state can shift with hormone levels. For women who wear glasses or contact lenses, this can translate to prescription instability: the same prescription that worked fine last year may feel slightly off this year, even though your eyes are otherwise healthy.
Blurry vision that fluctuates rather than being constant is a clue that hormonal changes (rather than a simple change in prescription) may be involved. Vision that is sharper in the morning and worse later in the day, or that varies on different days of the week, is worth discussing with an eye doctor with context about where you are in the menopause transition.
Women with a history of contact lens wear may notice that lenses feel drier, more uncomfortable, or feel less tolerable by the end of the day. Some women who wore contacts successfully for years find they need to switch to daily disposables, reduce wearing hours, or transition primarily to glasses during perimenopause.
Migraines with visual aura can also become more frequent during perimenopause due to hormonal fluctuation. If you are experiencing new or worsening visual disturbances, particularly if they accompany headaches, this is worth a medical evaluation to distinguish hormonally triggered migraine from other causes.
When to See an Eye Doctor
Not all vision changes during perimenopause are benign. Some require prompt evaluation.
See an eye doctor soon if you experience sudden vision loss in one or both eyes, sudden onset of floaters or flashes of light, a curtain-like shadow across part of your visual field, or eye pain combined with redness and nausea. These can be signs of retinal detachment, glaucoma attacks, or other conditions that require urgent care.
For dry eye and gradual vision changes, a routine eye exam is the appropriate first step. Tell your eye doctor you are in perimenopause and describe your symptoms in detail. Mention how long they have been occurring and whether they are constant or intermittent. Bring a list of all medications you take, since antihistamines, antidepressants, some blood pressure medications, and hormonal treatments all affect tear production.
Women in perimenopause should be screened for glaucoma and age-related eye diseases during their routine exams. The risk of glaucoma increases with age, and some research suggests estrogen decline may affect intraocular pressure. Annual or biennial comprehensive dilated eye exams are appropriate for most women in their 40s and 50s.
Practical Steps to Manage Dry Eyes
Artificial tears are the most accessible first line of management for mild to moderate dry eye. Preservative-free formulations are preferred, especially if you need to use drops more than four times per day. Drops labeled as containing hyaluronic acid or sodium hyaluronate tend to provide longer-lasting lubrication. Gel drops and ointments provide more relief but blur vision temporarily, making them better suited to nighttime use.
Reduce environmental triggers where possible. A humidifier in the bedroom significantly helps during winter when indoor air is very dry. Point car and office air vents away from your face. Wear wraparound sunglasses outdoors to block wind and reduce evaporation.
Follow the 20-20-20 rule during screen use: every 20 minutes, look at something 20 feet away for 20 seconds. This forces a blink reset and gives your eyes a brief break. Consciously remind yourself to blink fully and regularly when working on screens.
Warm compresses applied to closed eyes for five to ten minutes daily can improve meibomian gland function by liquefying the blocked oil secretions in the eyelids. This is particularly useful for the type of dry eye caused by poor oil layer quality.
Omega-3 fatty acids from fish oil or algae-based supplements have reasonable evidence for supporting tear film quality. Doses typically used in dry eye research range from 1,000 to 2,000 mg daily of combined EPA and DHA. Discuss with your doctor before starting if you take blood thinners.
What to Discuss With Your Doctor About Eye Health
Your primary care doctor or gynecologist may not routinely ask about eye symptoms during perimenopause discussions, but eye health fits into the broader picture of how hormonal changes affect multiple body systems.
If you are already considering hormone therapy for other symptoms, ask about its potential effects on dry eye. Some evidence suggests estrogen therapy may worsen dry eye for some women while androgen-containing preparations may help. Individual responses vary, and your eye health history is worth factoring into the conversation.
If you are using antihistamines for allergies or antidepressants for perimenopausal mood changes, ask whether these are contributing to dry eye and whether any alternatives exist.
Vitamin D deficiency is associated with poorer tear film quality in some research. Given that vitamin D deficiency is common in perimenopausal women, a blood test to check your level is a reasonable request.
Tracking Eye Symptoms Over Time
Eye discomfort during perimenopause tends to correlate with hormonal fluctuation, with symptoms often worse in the weeks before a period or during periods of high stress and poor sleep. Keeping a brief symptom record helps you identify patterns and communicate more clearly with your eye doctor.
Note when symptoms are worse, what conditions seem to trigger them, and whether treatments you have tried provide relief. PeriPlan lets you track symptoms over time, giving you a reliable record to bring to any appointment.
Your eyes deserve the same proactive attention during perimenopause as your heart, bones, and mood. Small, consistent steps in daily eye care can meaningfully reduce discomfort and help you maintain good vision throughout the transition and beyond.
Related reading
Get your personalized daily plan
Track symptoms, match workouts to your day type, and build a routine that adapts with you through every phase of perimenopause.