Dry eyes in menopause and perimenopause: why it happens and what helps
By Softer Mind · Updated 15 October 2026 · 7 min read · Based on NHS guidance and published research
Your eyes feel gritty, as if there's sand under the lids. They sting by the end of the day, especially after hours at a screen. Strangely, they might water more than ever. And your vision blurs, then clears again when you blink.
If you're in your 40s or 50s, you may wonder whether dry eyes and menopause are linked. The honest answer is: probably, yes, but the science is still patchy. The College of Optometrists says dry eye is more common in women and in people over 50, and that symptoms may be worse during the menopause. But dry eyes aren't on the NHS list of menopause symptoms, and researchers are still working out how hormones affect your tears.
The good news is that dry eye rarely causes lasting problems with your sight, and there's a lot you can do yourself. A red, painful eye is different, though, so please read the box below first.
Ask a GP or optician for an urgent appointment, or call 111, if:
- your eye is very painful and red
- you wear contact lenses and have a red eye (it could be an infection)
Call 999 or go to A&E if you have a red eye and:
- your vision changes, for example wavy lines, flashing lights or losing some of your sight
- it hurts to look at light
- you have a severe headache and feel sick
- your eye is very dark red
- you've hurt your eye, or something like grit or glass is stuck in it
Don't drive yourself. This comes from the NHS advice on red eyes.
What do dry eyes feel like?
The NHS lists these symptoms:
- itchy, sore or gritty eyes
- red eyes
- blurred vision
- eyes that are sensitive to light
- eyes that water more than usual
That last one surprises a lot of people. It sounds odd, but watery eyes are a common sign of dry eyes.
The College of Optometrists says dry eye can make your eyes feel scratchy or irritated, and make your vision blurry between blinks. It's often a long-term condition that comes and goes.
Can perimenopause cause dry eyes?
It seems likely, but the evidence isn't as strong as you might expect. Here's what we know:
- It's more common in women and over 50. Both the NHS and the College of Optometrists say being over 50 makes dry eyes more likely. The College adds that changes in hormones can raise the risk, so symptoms may be worse during the menopause, in pregnancy or on the contraceptive pill.
- It's easy to miss. A 2017 review of dry eye in perimenopause and menopause says dry eye is still very under-recognised in women of this age.
And here's what we don't know. The same review says there's a lack of large, long-term studies, and that research on hormone treatment has given mixed results. So if your eyes are dry, menopause may be part of it, but it's worth looking at the other causes too.
Why does menopause make your eyes dry?
Your tears aren't just water. The 2017 review explains that the film of tears over your eye has three parts:
- a watery layer, made by the tear gland
- an oily layer, made by tiny glands along the edge of your eyelids
- a sticky mucus layer, made by cells on the surface of the eye
The review says sex hormones help control how all three parts are made. That includes oestrogen and also androgens, a group of hormones that women make too, in smaller amounts.
The College of Optometrists says that when the tear film changes, it can become unstable. Tears may dry up too fast or spread unevenly, and the front of the eye can get inflamed.
It isn't as simple as "low oestrogen dries your eyes". The review says the glands in your eyelids have hormone receptors, and that androgens seem to help them make oil. Studies that measured hormone levels in women with dry eye have found conflicting results. So hormones are very likely involved, but nobody yet knows exactly how.
Age plays a part too. The College says tears and eyelids change as we get older, whatever our hormones are doing.
Other common causes of dry eyes
Before putting it all down to menopause, it helps to know what else can dry your eyes. The NHS lists:
- wearing contact lenses
- looking at screens for a long time without a break
- air conditioning or central heating
- wind, dust or dry air
- smoking, smoky places, or alcohol
- some medicines, such as some antidepressants and blood pressure medicines
- eyelid problems such as blepharitis
- conditions such as Sjögren's syndrome and lupus
HRT. This one may surprise you. A large US study of more than 25,000 women after menopause found that those taking HRT were more likely to have dry eye than those who weren't. The link was strongest for oestrogen on its own. That kind of study can't prove HRT caused it, and other studies have found the opposite. If your eyes got drier after you started HRT, tell your GP. Don't stop taking it without talking to them first.
Sjögren's syndrome. The NHS says this is a condition where the glands that make tears and saliva stop working properly. It's more common in women than men. As well as dry eyes, the main symptoms are a dry mouth, aching muscles and joints, and extreme tiredness. If that sounds like you, see your GP.
How to help dry eyes in menopause: things to try
These tips come from the NHS and the College of Optometrists.
- Clean your eyelids every day. Hold a warm (not hot) flannel over your closed eyes to loosen the oil in the glands. Gently massage your eyelids, then wipe them clean with cotton wool.
- Rest your eyes from screens. Take regular breaks when you're watching TV or using a computer or phone. Blink often and look away from the screen now and then.
- Set your screen just below eye level, as the NHS suggests.
- Make the air less dry. Try a humidifier, turn the heating down a little and keep out of draughts.
- Protect your eyes outside. Wraparound glasses can help on windy days.
- Give your eyes a break from contact lenses. Wear your glasses for a while instead.
- Go easy on eye make-up. The College suggests keeping your eyelids clean and not putting eyeliner on the inner edge of the lid.
- Avoid smoke. Don't smoke, keep alcohol down, and try not to spend long in smoky or dusty places.
If you think a medicine is drying your eyes, don't stop taking it. Talk to your GP or pharmacist first.
What a pharmacist, optician or GP can offer
A pharmacist can give you advice on cleaning and protecting your eyes. The NHS says they can tell you which eye drops, gels or ointments you can buy, and whether you need to see an optician or GP. The College of Optometrists says preservative-free drops are better if you need to use them a lot, so ask the pharmacist about these.
An optician (optometrist) can look closely at your tears and eyelids to find the cause. The College says they may suggest tiny plugs in the tear ducts to keep tears on the eye for longer. In severe cases, they may recommend prescription medicines or other treatment.
A GP can check for a cause, such as a medicine or another health condition. If no cause is found, the NHS says they may refer you to an eye specialist (ophthalmologist) for tests.
What about HRT? This is where the evidence is really mixed:
- A 2018 review of 7 small trials found hormone therapy was linked to better results on one test of tear production. It found no clear difference on other tests, including how comfortable eyes felt. The authors said bigger, better trials are needed.
- The large US study found the opposite: more dry eye in women taking HRT.
- The 2017 review says eye lubricants are the first step for dry eye in this age group.
So HRT isn't an established treatment for dry eyes. But if you have other menopause symptoms as well, it's worth talking them all through with your GP. Mention your eyes too, especially if you start or change HRT.
When to see an optician or GP about dry eyes
The NHS says to see an optician or GP if:
- your eyes are still dry after a few weeks of trying things at home
- the shape of your eyelid has changed
It's also worth making an appointment if:
- you have a dry mouth, aching joints or extreme tiredness as well. Together with dry eyes, these can be signs of Sjögren's syndrome
- dry eyes are getting in the way of reading, driving, work or sleep
- you think a medicine, including HRT, might be the cause
And go sooner, using the box at the top of this page, if your eye is red and painful, your vision changes or light hurts your eyes.
It can help to take a list of all your symptoms with you, even the ones that seem unrelated. Our symptoms checklist lets you tick them off and print a list for your GP.
Related
Dry eyes often come with a dry mouth, skin changes and itchy skin, and you can see them all in our list of perimenopause symptoms.
This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.
