Hormonal changes during perimenopause and menopause affect far more than reproductive health—they can have significant implications for ocular surface disease, glaucoma risk, retinal health, and overall visual function. During the recent continuing education session at Optometry’s Meeting 2026, “Women’s Hormonal Health and Its Impact on Ocular Disease: What Every Eye Care Provider Should Know,” Neda Gioia, OD, CNS, FMCP, FOWNS, explored the growing body of evidence that links hormonal transitions to eye disease and learned practical strategies for integrating these insights into clinical care.
"What drew me to this topic is the intersection of 2 areas that have shaped much of my professional journey. My training in functional medicine reinforced the importance of viewing health through a systems-based lens, recognizing that hormones, metabolism, inflammation, nutrition, and aging are deeply interconnected,” Dr. Gioia told OM. “At the same time, women's health is finally receiving the attention it has long deserved. We recognize that women bear a disproportionate burden of many ocular diseases, yet only recently have we begun to better understand the biologic and hormonal factors that may contribute to those differences. The more attention we bring to this area, the greater our opportunity to improve understanding, advance research, and ultimately create better solutions for the women we serve."
Hormones Influence Nearly Every Ocular Structure
One of the course's foundational messages was that the eye is not hormonally isolated. Estrogen, progesterone, and androgen receptors are present in the cornea, conjunctiva, meibomian glands, lacrimal glands, retina, retinal pigment epithelium, optic nerve, and other ocular tissues. These hormones help regulate tear production, inflammation, wound healing, lipid secretion, intraocular pressure (IOP), and neuroprotection.
According to Dr. Gioia, ocular health is influenced not only by hormone levels but also by the balance among estrogen, progesterone, and androgens—resulting in a higher burden of ocular disease in women.
Dry Eye Disease: Early Menopause Indicator
Dry eye disease, Dr. Gioia shared, affects twice as many women as men over the age of 50 and is often linked to hormonal imbalance during menopause. Fluctuations and declines in estrogen, progesterone, and even androgens during perimenopause can disrupt tear film stability, reduce tear production, and impair meibomian gland function. Dr. Gioia suggested that menopausal dry eye is not caused by a single hormone deficiency but rather by hormonal imbalance that promotes inflammation and gland dysfunction.
When evaluating women in their 40s and 50s with new or worsening dry eye symptoms, ECPs should consider asking about menstrual status, hot flashes, sleep disturbances, and other menopausal symptoms. Ocular surface complaints may be one of several manifestations that emerge during the menopausal transition and can provide an opportunity for broader discussions about women's health.
Menopause and Glaucoma Risk
Emerging research suggests menopause may be a sex-specific risk factor for glaucoma because reduced estrogen levels may affect both IOP regulation and retinal ganglion cell survival, which potentially increases susceptibility to optic nerve damage.
Several studies highlighted during the presentation found associations between earlier menopause and increased risk of primary open-angle glaucoma (OAG). One meta-analysis reportedan associated 89% increased risk of OAG among women experiencing menopause before age 45.1
As research continues to evolve, reproductive history may emerge as a valuable consideration in the broader assessment of glaucoma risk among women.
Ocular Findings Can Reveal Systemic Health Risks
The course also explored how menopause-related metabolic changes can present in the eye. Lipid profiles often worsen during the menopausal transition, potentially increasing cardiovascular risk. One example discussed was corneal arcus: Although common in older adults, corneal arcus identified in patients younger than 50 may warrant lipid profile investigation for underlying dyslipidemia.
Dr. Gioia suggested ECPs use ocular findings as opportunities for systemic health conversations and referrals when appropriate.
Nutrition and Lifestyle
Dr. Gioia discussed what she describes as the Menopause–Ocular Nutrition Axis, which refers to the interconnected relationships between nutritional shifts during menopause and ocular health in midlife women. Topics included omega-3 fatty acids, vitamin D, B vitamins, antioxidants, lutein, and zeaxanthin. As estrogen levels decline, the body’s ability to convert plant-based omega-3 precursors into docosahexaenoic acid decreases, making dietary intake increasingly important. Lifestyle factors—such as sleep, movement, metabolic health, and gut health—were also highlighted as contributors to inflammation and long-term ocular outcomes.
Incorporating brief nutrition and lifestyle discussions into care plans for midlife female patients, particularly those with dry eye, glaucoma risk factors, or retinal disease, can signal need for intervention.
Menopause-Informed Eye Care
Perhaps the most important takeaway was the need for a more multidisciplinary approach to patient care. Collaboration with gynecologists, endocrinologists, cardiologists, nutrition professionals, and other specialists can help address the interconnected health challenges women face during midlife.
As research continues to clarify the relationship between hormonal health and ocular disease, ECPs are increasingly positioned to identify early warning signs, educate patients, and play a meaningful role in preserving vision and overall health during the menopausal transition.
Reference
1. Kai J-Y, Zhou M, Li D-L, Zhu K-Y, Zhang X-F, Pan C-W. Reproductive factors and the risk of open angle glaucoma in women. J Glaucoma. 2023;32(11):954-961. doi:10.1097/IJG.0000000000002292