The thought of one more menopause symptom could make just about any woman cry, but for women suffering from one of the more common symptoms of menopause, what might appear to be tears could be eye irritation caused by dry eye syndrome. Changes in hormone levels may be to blame, but sweet relief is available.
By the time she reached menopause, Lynn Adams was fully prepared for hot flashes and night sweats. What she didn't expect were the changes that affected her eyes. "I felt like I had sand in my eyes every hour of the day," says the 53-year-old from Atlanta, Ga. "One minute they were burning and irritated; the next they were feeling terribly tired."
For Adams, eye discomfort was the most unpleasant of her menopause symptoms. Known as dry eye syndrome, it's a common, yet annoying, condition that often surfaces in perimenopausal and postmenopausal women. But, while it can cause a lot of discomfort, it rarely threatens sight.
So what exactly happens in dry eye syndrome? Tear production decreases naturally with age, but around menopause this can be exacerbated by hormonal changes (particularly falling androgen levels), which subtly increase inflammation in the eye. Because the lacrimal gland, known as the tear gland, isn't producing sufficient tears to keep the conjunctiva and cornea covered, the eyes dry out and become irritated. Then they suddenly produce a large amount of tears to compensate, explains Stephen Pflugfelder, M.D., professor of ophthalmology at Baylor College of Medicine in Houston, Texas.
You may experience dry eye as an overly watery eye, or you may feel stinging, burning, scratchiness, and the feeling that there's something in your eye. Occasionally, environmental factors such as low humidity or winds can worsen symptoms.
Hormone receptors have been identified in many parts of the eye, and it is known that the quantity of tears produced is lower in postmenopausal women. In America, 3.2 million women are affected with dry eye syndrome. Luckily, some simple changes can help. Craig Skolnick, M.D., an ophthalmologist at Bascom Palmer Eye Institute in Palm Beach, Fla., recommends:
• Avoid sitting close to air blowing from fans and air conditioning vents
• Use a humidifier, particularly during the winter months when indoor air is drier
• When using a computer, make sure you blink often and take frequent breaks.
• Keep your computer screen at or below eye level so your eyes don't have to open quite so wide to see the screen; that way they'll be less likely to dry out
Protect Your Sight
Not all eye conditions are as benign as dry eye syndrome. Some, such as macular degeneration and glaucoma, can lead to vision loss or even blindness. And this issue is particularly relevant for women, who are nearly three times as likely as men to lose their sight. Worldwide, studies show that women make up two-thirds of those who are blind.
But you can protect your vision with good eye care and some healthy lifestyle changes. "Women reaching menopause should have a complete eye exam," says Janine Smith, M.D., deputy clinical director of the National Eye Institute in Bethesda, Md. "You can't take your eye health for granted, just like you can't take any other part of your body for granted."
The Aging Eye
While dry eye may have a hormonal basis, other eye conditions related to aging are simply the result of, well, age. Many of us reach midlife already using glasses or contacts to see objects far away. But as we age, the lens of the eye, which helps focus images, loses its flexibility. This results in presbyopia, difficulty in seeing objects close up.
The solution may be reading glasses or bifocals, or possibly one of the newer laser surgeries that may give you back your pre-forties vision, at least for a while.
Floaters-those shadowy squiggles and dots that drift into your field of vision-also increase as we age. They're the result of changes in vitreous gel, liquid inside the eye that helps give it its shape. You usually don't need to worry about floaters, says Skolnick. They're just the outlines of debris drifting along in the liquid. However, if they suddenly increase, see an eye specialist immediately. They could be a sign of a detached or detaching retina.
Then there are the big guns of aging eyes: cataracts, macular degeneration, and glaucoma-leading causes of blindness and vision loss in older Americans.
Cataracts, or a clouding of the lens in the eye, used to be the primary thief of eyesight in the elderly. Today, however, a simple, outpatient procedure to remove the cloudy lens and replace it with an artificial lens is one of the most commonly performed surgical procedures in the country.
Your risk of cataracts increases with age, sun exposure, smoking, diabetes, steroid use, or a family history of cataracts. A few studies show that estrogen users have fewer cataracts.
Age-related macular degeneration, or AMD, destroys the cells in the macula, the part of the eye responsible for central vision. It can begin in middle age, with the risk increasing as you get older. As a woman, your risk of AMD is higher than a man's. It's also higher if you're white, smoke, or have a family history of the disease.
Glaucoma is usually caused by increased pressure from the buildup of fluid in the eye, which can slowly damage the optic nerve. You are at risk if you are over 60, African American, Mexican American, have a family history of the disease, have ever had an eye injury, have diabetes, or have taken steroids. If caught early, drugs can keep glaucoma under control, preventing vision loss.
Regular eye exams are so important, says Skolnick. Early detection, along with lifestyle changes (See "Boost Your Eye Health" below) to boost eye health, will help ensure your eyes remain in optimum condition as long as possible.
Boost Your Eye Health
About three-quarters of all vision loss is preventable or correctible, says the National Eye Institute's Janine Smith, M.D. Healthy lifestyle changes, along with regular eye screenings and early treatment, can make a difference in quality of life.
Stop smoking. The chemicals in cigarette smoke travel in the blood to every cell in the body and can cause eye damage in addition to other problems. For example, studies find that about one-third of macular degeneration cases may be caused by smoking.
Lose weight. A healthy diet and regular exercise appear to reduce the risk of serious eye disease. Manage your weight to reduce the risk of diabetes, which is a major risk factor for cataracts, glaucoma, and a nerve-destroying condition called diabetic neuropathy.
Eat an apple a day. Several studies suggest diets rich in fruits and vegetables may reduce the risk of cataracts and macular degeneration by providing valuable antioxidants to prevent age-related damage. Vitamin supplements may be necessary if you find it hard to increase your level of antioxidants.
Shade out the sun. Too much sun exposure can lead to cataracts and macular degeneration, says Smith. Look for sunglasses that block 90 percent to 100 percent of both UVA and UVB light.
Managing Dry Eye
Eyedrops. Over-the-counter artificial tears may be helpful, but they're only likely to ease symptoms. Make sure you choose a product specifically designed for dry eyes, not just to get the redness out.
Anti-inflammatories. If over-the-counter drops don't work, the prescription eye drop drug cyclosporine (Restasis(r)) could be the next step. Restasis dampens the eye inflammation that leads to irritation and tearing.
Punctal plugs. These tiny silicone plugs block the drain that normally allows tears to flow down the nose. If the plugs fall out, your healthcare provider may decide to cauterize the drains to permanently close them.
Corticosteroids. Studies show corticosteroids eye drops provide some symptomatic relief. They may have adverse effects, though, so they're not suitable for long-term use.
Hormones and the Eye
Research has shown that various changes in the eyes may occur during the menstrual cycle, during pregnancy, and at menopause, indicating a hormonal impact since these are the times when a woman's hormonal levels change. Visual performance may be altered, and tolerance to contact lenses may be reduced.
Other eye conditions often reported by postmenopausal women include dry eye, increased tearing, burning, sensitivity to light, blurred vision, tired eyes, swollen or reddened eyelids, sensation of something in the eye, and scratchiness.
There are no well-documented gender differences in cataract formation, which rarely occurs during a woman's reproductive years, although some studies have shown that estrogen therapy may lower a woman's risk. Women who experience surgically induced menopause may have a greater risk of cataract formation than women reaching menopause naturally. And women with breast cancer treated with tamoxifen (Nolvadex(r)) have an increased risk of cataracts, which is consistent with a protective role for estrogen.
Studies are ongoing to determine the effects of menopause and hormone therapy on eye disease, including glaucoma and macular degeneration.
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