Medical Edge Newspaper Column

Dry Eyes After Menopause

April 1, 2007
Dear Mayo Clinic:
I took low-dose Premarin (estrogen) from age 36, when I had a hysterectomy, until I was 71. Now I'm 73, and I have been diagnosed with dry eyes and blepharitis. I've used artificial tears and other eye drops, and also wash my eyelids twice daily with baby oil after using a warm compress. Could my blepharitis and dry eyes, which just started recently, be helped by reintroducing hormones? -- Spring Hill, Fla.

Answer:
Problems with dry eyes increase with age, particularly in women over 50-55 years old. How much of this is due to estrogen deficiency -- i.e., menopause -- and how much is caused by other aging factors is not known. Resuming estrogen just for any possible benefit to the eyes is not recommended.

However, women who have taken estrogen therapy ever since a hysterectomy accompanied by removal of the ovaries, and at a young age, typically feel better continuing this therapy indefinitely. If you are having troublesome menopausal symptoms after discontinuing long-term estrogen therapy, talk to your doctor about the pros and cons of resuming it.

For some people, the cause of dry eyes is an imbalance in the composition of their tears. Other individuals don't produce enough tears to keep their eyes comfortably lubricated. Eyelid problems, medications, and other causes, such as environmental factors, also can lead to dry eyes. We know from your question that at least one of these causes applies here -- blepharitis is an inflammation of the eyelids resulting from abnormal secretions and debris that is shed. This inflammation can interfere with the functioning of some of the tear-producing glands in the eyelid and lead to dry eyes.

Your doctor has you on treatment for blepharitis, but there are two possible reasons why this procedure hasn't worked for you. The first is that, unless there is a typographical error in your question, you are using baby oil instead of the recommended baby shampoo, aimed at washing eyelid secretions and debris away. Baby oil could exacerbate the problem, perhaps offsetting any benefits from the artificial tears and other eye drops you've taken.

The second reason is that while blepharitis is a cause, it is not necessarily the only cause for some people with dry eyes. Thus the washing regimen, even when corrected, may be confounded by other factors that result in poor tear quality or insufficient tear production.

Because one must often try several different approaches before getting relief from dry eyes, it's important to work with your eye doctor to find the approach that's best for you. Switching brands of over-the-counter artificial tears sometimes helps. If not, your physician may prescribe steroid drops or, as a last resort, the drug cyclosporine (Restasis) -- an FDA-approved medication for chronic dry eyes. However, steroids and cyclosporine both have potentially harmful side effects and require careful clinical surveillance.

A "conserving tears" approach, as opposed to adding or increasing production of tears, is also possible. It involves a partial or complete closing of your tear ducts -- temporarily, with tiny silicone plugs, or permanently through surgery.

It's also possible that a source of your dry eyes is relatively simple and easy to reverse. The problem could be a side effect of a medication you're taking for some other disorder -- diuretics, other blood-pressure drugs, decongestants, or sleeping pills, among others -- or it could derive from an environmental condition such as exposure to wind or hot blowing air. In such cases, you may just need to eliminate, or adjust for, the cause.

Also, a variety of self-care practices can help to ease the problem. These include not directing hair dryers, car heaters, air conditioners, or fans toward your eyes; wearing glasses on windy days and goggles while swimming; keeping your home humidity between 30 and 50 percent; not rubbing your eyes; and remembering to blink often (which spreads tears more evenly).

-- Lynne T. Shuster, M.D., F.A.C.P., Women's Health Clinic, and J. Douglas Cameron, M.D., Department of Ophthalmology, Mayo Clinic, Rochester, Minn.