Whether you wear contact lenses or not, dry eyes may be one of the first changes you notice around menopause. A decade ago many eye doctors dismissed complaints of dry eyes without much thought. But these days doctors are recognizing that dry eyes can lead to bigger problems: chronic inflammation, increased risk of infection, blurred vision, scarring and, in rare cases, corneal damage and vision loss. More commonly, dry eyes interfere with daily life, making it harder for you to read, drive a car (especially at night), work at a computer and even go out into the sunlight.
Your eyes may be feeling gritty because you're not producing enough tears, or the tears you have evaporate too quickly. Sometimes this is related to aging, a malfunction of the tear glands or illness. Dry eyes are associated with rheumatoid arthritis, lupus, Sjögren's syndrome, diabetes, Parkinson's and thyroid disease. But there's lots of evidence that dry eyes are related to fluctuations in hormones, especially androgen, which affects the production of the watery and oily layers of your tears.
To deal with it, start a dry-eye diary to determine how often and under what conditions dryness tends to occur. Many women find that environmental and lifestyle changes can make a real difference. For example, you may experience significant relief by reducing your exposure to pollution, air conditioning, blow dryers, and overheated rooms and cars. It also helps to drink more liquid (while reducing caffeine), use a humidifier, or switch from contact lenses to eyeglasses. Try putting more omega-3 fatty acids in your diet by eating more fatty fish, walnuts, flaxseed or canola oil.
You may be able to get some additional relief with over-the-counter preservative-free artificial tears. (While products with preservatives have a longer shelf life and usually cost less, they can also be more irritating to your eyes.) If that's not enough, make an appointment with an eye doctor, who has an arsenal that includes medication and other interventions.
The clear lenses inside your eyes will become less flexible as you age, which will make it harder for you to focus on small print and tiny details. This is called presbyopia. Many women find they need reading glasses as a result. The lenses also start to slowly yellow. Try brighter and more direct light on the pages you're trying to read.
Even if your eyes aren't dry or causing any other problems, it's time to start getting regular checkups with an eye doctor to ensure early detection of eye diseases associated with aging. Some, like glaucoma (which has no symptoms and causes no pain), can start showing up in your 40s and 50s. Untreated, it can lead to blindness.