Dry, Watery, Blurry Eyes: Why Menopause Messes With Your Eyes (And What Can Help). With optometrist Sarah Wright.

Sarah is my optometrist. Actually, Sarah and Sally both are. I’ve been asking my health team members specifically about what their ‘area of body expertise’ is affected in peri-menopause and post-menopausally. To get the facts straight from the expert’s mouth. I had my bi-annual eye exam recently and asked Sally if there are any conditions she knew of that are more prominent in midlife, that are attributable to menopause?Instantly, she said “yes, Dry Eye Disease“ and “Sarah is the one to speak about it. (Yep, she threw Sarah straight under the bus. Thankfully they’re great mates). And Sarah said “yes”. We talk a lot about how menopause dries things up - skin, mouth, vagina. You know. You can probably add a few more to the list.Turns out, dry eyes are too and most of us have no idea. Why is that? Is it the lack of research? Lack of clinical knowledge? Or the simple fact that we’re just not talking about it? Probably all 3. So today Sarah and I are changing that. With her 20+ years of clinical and academic experience in optometry, running a dedicated Dry Eye Clinic and as a woman in midlife, Sarah is perfectly positioned to talk to us about what happens to our eyes in this time of life and what we can do to help them as we age. Yep, she’s our gal!Because that blurry vision you blame on needing a new prescription, or thinking your watery, gritty, tired eyes are because of seasonal changes (and the season of your life), this episode is for you.Let’s go!In this conversation Sarah and I talk about…Some of the most common eye conditions women in midlife experience and their symptoms. Conditions we experience more than our male counterparts. Conditions that are not just because we’re getting older. Some are, some are not.Conditions like:* Dry Eye Disease* Glaucoma & * CataractsDry Eye Disease: it’s sneakier than you think. Hormonal fluctuation (not just decline) of the usual suspects, oestrogen, progesterone and testosterone, sets off an inflammatory response that messes with our tear film. Causing…* Vision that blurs, clears when you blink, then blurs again* Eye fatigue (yes, on top of all the other fatigue)* Light sensitivity* Red eyes* Watery eyes - counter-intuitive really when thinking about dry eyes. Often it’s either unstable tears sliding right off the eye, or your eyes overcorrecting with reflex tears because they’re actually too dry* Contact lenses suddenly feeling impossible after 20 problem-free years* Worse symptoms by end of day (screen time = fewer blinks = more evaporation) OR worse, first thing in the morning (your eyelids may not be sealing fully overnight - eek!) Why Care About Dry Eyes?: Because if you don’t address it, it slowly escalates. Sarah has clients in their 80’s dealing with severe, constant dry eye discomfort. Something that could have been avoided or at least eased with age. What actually helps:* Get properly assessed by a reputable optometrist. There are specific questionnaires and examinations on purpose designed equipment that show which part of your tear system isn’t working. Facts about your eyes you have no way of knowing just by looking at them in the mirror!* Preservative-free eye drops, twice daily, as a starting point (maybe up to 4 times a day)* Warm compresses* Omega-3s (1–2 a day) - these work directly on the oil glands themselves, may help the oil stay more fluid and less inflammatory* Vitamin D (of course it’s vitamin D, it’s always vitamin D - the great all-rounder)* Probiotics - gut inflammation shows up on your eye’s surface too (who knew?!). Gut bacteria produce their own anti-inflammatory compounds that travel to the eye whilst some can degrade our eyes.* In-clinic treatments like IPL (Intense Pulsed Light) to unclog and restart those oil glands👀 Glaucoma: in midlife, menopause and beyondThis is about blood supply to the optic nerve, not tears. Migraines, snoring/sleep apnea and low blood pressure (especially overnight dips) are all associated with increased risk of Glaucoma (especially Normal‑Tension Glaucoma). Genetics also play a part. First-degree relatives matter most here. If it’s your mum or your gran, pay attention. There’s now a genetic test (about $200AUD) that checks for the relevant genes. The Eye Pressure Myth - you can have totally normal eye pressure and still have nerve damage from reduced blood flow. Oestrogen has a hand in this one too. Oestrogen receptors are in the eye’s internal drainage system where it appears to help keep fluid flowing out properly. It’s a newer research thread, so it’s ‘watch this space’ but it’s a plausible extra piece of why women’s glaucoma risk shifts around midlife.🌫️ Cataracts: the great equaliser. Unlike Dry Eye and Glaucoma, this one’s not particularly female-forward so is attributed more to aging. As Sarah put it, “a sign of a well-lived life.” Cataracts occur in the lens inside your eye, slowly clouding from a lifetime of UV exposure. Watch for needing more light to read, seeing best in sunlight and night driving throwing light as a detracting and interfering ‘starburst’. Usually shows up 70’s–80’s, though some types appear earlier.What Can You Do To Optimise Your Eye Health?The Australian Optometry Association guidance says to have a reputable Optometrist check the health of your eyes every 2 years until you’re 65. Then go annually. In Australia Medicare only fully rebates every 3 years for those of under 65 - a gap between what’s recommended and what’s funded. Over 65, Medicare matches the annual recommendation. As with many aspects of health, the earlier problems are detected, the more likely a better outcome. For Future You (and Me). Odds on you won’t have the eye health conversation with your GP (primary provider) in your annual check up. It will be up to you to get on top of your eye checks and keep them up. Sarah’s Closing Advice“Don’t let it go. The longer you leave it, the harder it is to get effective help and treatment.”Whatever’s going on with your eyes…dry, gritty, blurry, watery, whatever, the earlier you get it looked at, the easier it is to treat and the less effort is needed to have optimal eye health, in midlife and beyond.Don’t wait. Consider this your permission, your loving nudge to get it done.Resources: Dive in a little deeperSarah mentioned some research behind the inflammation angle, so here’s the deeper reading if you want to go down the rabbit hole with me:On inflammation as the real driver of Dry Eye:* TFOS DEWS III (diagnosis/framework)* Source: Tear Film & Ocular Surface Society (TFOS). DEWS III Diagnostic Methodology. 2025.* Link: https://www.ajo.com/article/S0002-9394(25)00275-2/fulltext* Immuno‑inflammatory axis of menopausal dry eye (hormone‑driven inflammation)* Source: [Authors]. Immuno‑inflammatory axis of menopausal dry eye: from hormonal changes to ocular surface inflammation. Frontiers in Immunology. 2026.* Link: https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2026.1732320/fullGlaucoma - blood flow, not tears:* “Beyond IOP: The Vascular Side of Glaucoma” (migraines, OSA, nocturnal BP dips, perfusion pressure)* Source: [Authors]. Beyond IOP: The vascular side of glaucoma. Review of Optometry. 2026.* Link: https://www.reviewofoptometry.com/article/beyond-iop-the-vascular-side-of-glaucomaThe gut-eye connection:* The impact of probiotics and prebiotics on ocular and systemic inflammation in dry eye disease — a randomised controlled trial (2025)* Source: [Authors]. The impact of probiotics and prebiotics on ocular and systemic inflammation in dry eye disease — a real randomised controlled trial. 2025.* Link: https://pubmed.ncbi.nlm.nih.gov/40401608/* Gut-derived butyrate suppresses ocular surface inflammation — mechanism paper* Source: [Authors]. Gut-derived butyrate suppresses ocular surface inflammation. [Journal]. 2022.* Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8927112/Get in Touch with SarahSarah practices at EyeCarePlus, Ashgrove (Brisbane). If you’re local and want to get your eyes properly checked that’s where to find her. I personally vouch for her and Sally as exceptional professionals. So knowledgeable, capable and caring. And they’ve got the latest equipment too!This podcast episode and show notes are for general information and conversation.A quick note: Remember, this episode and these show notes are for general info and a good chat. Not personal medical advice. Everyone’s eyes (and hormones) are different, so please check in with your own optometrist or doctor before changing anything, especially if something feels off. When in doubt, get it checked.I hope you found a few gems in this episode? If you did, share it on with someone you think will find it helpful. See you next time on Midlife Unfiltered. 💛Anita xxp.s. A big thank you to everyone who tuned into the live video! Join me for my next live video in the app. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit midlifeunfiltered.substack.com