Experts urge optometrists to ‘sow the seed’ about menopause in dry eye consultations

Today, dry eye disease is a common condition managed in optometry practice. Yet one key driver of the condition in women, which can often go undiscussed, is hormonal change.

Opening a session on day one of 100% Optical (28 February–2 March), titled Tearful times – understanding the links between menopause and dry eye, panellists Nicola Bennett, Mandy Davidson and Priya Udani asked delegates to raise their hands if they felt comfortable discussing menopause in routine practice. Around half of those present did.

For many women, the connection between fluctuating hormones and worsening ocular surface symptoms is not obvious, Bennett, head of education at Keeler and chair of the session, shared with delegates.

Throughout the session, panellists highlighted that as awareness of menopause grows, eye care practitioners are uniquely positioned to recognise its impact on ocular surface health and, importantly, to start conversations with patients.

Optometrist Davidson and ophthalmologist Udani emphasised that, when navigating this conversation, practitioners should focus on keeping the message simple, making it feel natural and supportive rather than clinical or intimidating.

Davidson shared that in practice she aims to keep discussions around menopause and dry eye practical and patient centered. She highlighted the importance of a “softly, softly” approach. Rather than telling a patient, ‘This could be menopause,’ she recommended to delegates – as she does in her own practice – exploring symptoms first.

Davidson, medical and professional affairs manager at Scope Ophthalmics, told delegates that she routinely asks about dry eye symptoms during a patient’s history-taking, recognising that many patients do not associate irritation, fluctuating vision, or tired eyes with dry eye. Once symptoms are established, she explains that dry eye is multifactorial, with hormones as one possible influence among many.

If age and context make it relevant, Davidson shared that she will explain that hormonal changes can affect the tear film and ask whether the patient thinks this could be contributing.

The optometrist is particularly mindful of women in their mid-thirties and early forties and uses language such as “hormonal fluctuations” or “changes at this stage of life.” Her aim is to plant a seed, acknowledging that delicacy matters as many women are not ready to hear the word “menopause.”

In terms of clinical management, Davidson and Udani both emphasised starting simple. For meibomian gland dysfunction, they prioritise heat therapy, highlighting that technique matters: the compress must reach an adequate temperature and be applied for long enough to soften the meibum properly.

Both discouraged delegates from recommending using a hot flannel, explaining that it cools too quickly and can scald delicate eyelid skin.

Davidson shared that after assessments she provides patients with written dry eye care sheets outlining what was discussed, adding her contact details and the next appointment date at the bottom to ensure patients can reach out if needed.

The importance of raising hormonal changes with relevant dry eye patients was brought home through a case study shared. In the case study, a 51-year-old patient who worked extensively on screens had reached the end of her tether and felt she could no longer cope. When the possibility of hormonal influence was gently introduced the patient admitted that she thought she was going mad and acknowledged relief that it made sense now.

The panel concluded that raising awareness of menopause within eye care is not about stepping beyond professional scope, but about practising a holistic approach.

“As clinicians, we are often the first to observe patterns patients have not yet connected, and a brief, thoughtful comment may prompt a GP conversation that transforms a woman’s broader health journey,” they said.