Why Is Dry Eye More Common Among Women?
The major reason that women are at risk for dry eye is due to the hormonal changes that occur throughout their lifetime. The fluctuation of estrogen, progesterone, and testosterone (among other hormones) affects tear quality and production. More specifically, high levels of estrogen and low levels of testosterone both contribute to DES.
Women taking oral contraceptives may also experience dry eyes as a side effect. This is because the reduction in androgen levels due to the pill may impact the amount of tears produced and reduce tear-film stability.
The hormonal changes that occur during pregnancy can also lead to DES, leading pregnant women to stop wearing eye makeup or contact lenses due to heightened eye sensitivity. Furthermore, morning sickness may contribute to dry eyes as vomiting can cause dehydration, and because the eyes are part of a whole system, a dehydrated body often means dehydrated eyes.
Women who wear eye makeup, such as mascara and eyeliner, have an increased risk of developing dry eye due to irritating ingredients found in these products. It should also be noted that makeup removers often contain oil and harsh chemicals that can thin out the tear film covering the eye, causing the tears to evaporate prematurely.
Though women of all ages have a higher chance of developing dry eye than men do, those over the age of 50 are more susceptible to it.
Post-Menopausal Women and Dry Eyes
An estimated 38% of post-menopausal women in North America use hormone replacement therapy (HRT) to manage menopausal symptoms. A common side effect of HRT is dry eye, especially if estrogen alone is administered.
A study published in the Journal of the American Medical Association followed approximately 25,000 women over the course of 4 years to determine the relationship between HRT and dry eye syndrome. The results show that women using HRT with estrogen alone increase their risk of developing dry eye by 69%, and women who use a combination of estrogen and progesterone are 29% more likely to experience dry eye symptoms than women who don’t use HRT at all.
The risks and benefits of HRT should be discussed with a primary caregiver or gynecologist before starting treatment, particularly if there is a history of dry eye or other ocular conditions in the family.
Other medications popularly prescribed to patients over 50 can also contribute to dry eye symptoms, such as diuretics, antidepressants, and beta-blockers.