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Dry eye disease affects women at approximately twice the rate of men, yet the relationship between women’s health and the ocular surface is often overlooked. In a conversation on The 20/20 Podcast, Dr. Harbir Sian and Dr. Janice Luk explored how hormonal changes, beauty routines and inflammation can influence dry eye throughout a woman’s life and why optometrists must become more comfortable discussing these factors with patients.
Topics Covered :
Hormones and the Ocular Surface
Hormonal balance can directly affect tear-film stability and meibomian gland function. Dr. Luk explained that the meibomian glands respond to androgens, which help support the production of the oils that prevent tears from evaporating too quickly. When androgen levels decline or hormones become imbalanced, oil production may decrease, contributing to evaporative dry eye.
Estrogen may also influence ocular surface inflammation. According to Dr. Luk, elevated estrogen levels can increase MMP-9, an inflammatory marker associated with dry eye disease. These relationships are complex, making it important to assess the overall hormonal picture instead of identifying one hormone as entirely beneficial or harmful.
Dry Eye Across a Woman’s Life
Hormonal fluctuations can begin affecting the eyes well before menopause. Oral contraceptives may reduce androgen levels, while pregnancy can produce unpredictable changes in dry eye symptoms. Later, perimenopause and menopause may create additional tear-film instability and ocular discomfort.
Rather than briefly mentioning hormones and moving on, optometrists can ask whether patients have noticed hormonal changes, undergone hormone testing or started hormone replacement therapy. As Dr. Luk emphasized, dry eye is multifactorial, and hormonal health may be one important part of the larger clinical picture.
Beauty Without Sacrificing Eye Health
Cosmetics, lash extensions, lifts and tints are closely connected to many patients’ identities. Simply advising patients to stop using them can damage trust without changing behavior.
Dr. Luk recommends a collaborative approach. Optometrists should ask how patients remove their eye makeup, clean lash extensions and respond when a beauty treatment causes irritation. Foaming cleansers and hypochlorous acid may support eyelid hygiene, while patients receiving lash lifts can ask their artists about gentler cysteamine-based systems.
“How do we empower patients to get these beauty trends done in a way that they can still take care of their ocular surface?” Dr. Luk asked.
Treating Inflammation Earlier
The discussion also highlighted a shift away from waiting for dry eye to progress before prescribing anti-inflammatory treatment. Artificial tears, warm compresses and nutritional support remain valuable, but prescription immunomodulators may be appropriate earlier when inflammation is present.
The central takeaway is simple: ask better questions and create a judgment-free environment. “Don’t be afraid to bring it up to patients,” Dr. Luk advised. “They appreciate it as long as they know that you’re on their side.”
