Dry eyes in menopause

Normally, the corneal epithelium is constantly moistened by a tear film. It is restored involuntarily during blinking and ensures easy gliding of the eyelids over the surface of the eyeball, protection of the eye surface from drying out, infection, contamination, contains substances that promote rapid regeneration of the corneal epithelium as a result of microtrauma. Corneal-conjunctival xerosis (xerophthalmia or "dry eye" syndrome) is a pathological decrease in the moisture content of the corneal epithelium caused by a deficiency of tear fluid or its accelerated evaporation. The incidence increases with age; in people over 45, this syndrome is quite common. About one fifth of the inhabitants of countries with a high level of technological development suffer from this pathology. Over the past thirty years, the frequency of xerophthalmia diagnosis has increased by 4.5 times. Women are more susceptible to this disease (≈70% of all those who seek help with this problem), most of them are post-Balzac age office workers.

Causes menopausal dry eyes

The onset of menopause in women is often accompanied by a feeling of dry eyes. Climacteric syndrome is the second most important and frequent cause of this pathology.

Changes in hormonal levels result in insufficient production of sebaceous secretion of the basal phase of the lacrimal fluid. The lipid layer of the lacrimal foam is the outer one, it reduces surface heat transfer and does not allow the next, aqueous layer, directly produced by the lacrimal glands, to evaporate. This is the largest part of the lacrimal film, continuously renewed and conducting nutrients to the cornea and conjunctiva, and also removing metabolic products. The inner layer, mucin, glues the lacrimal film to the cornea, a factor in the development of its insufficiency is often a deficiency of retinol (vitamin A), characteristic of the climacteric period. The process of producing components of all layers of the lacrimal film occurs continuously, which ensures its stability on the outer surface of the eye. The pathogenesis of dry eye syndrome is based on disturbances in this process, the overwhelming majority (85%) of cases are the result of excessive evaporation of the lacrimal film, 15% of patients usually have reduced production of lacrimal fluid.

The likelihood of dry eyes during menopause is aggravated in women whose work is associated with office work on a computer. Dry air, tobacco smoke, dust, Sjogren's disease, wearing contact lenses, hormone replacement therapy, taking sedatives, diuretics, hypotensive drugs in addition to age-related changes are risk factors for the occurrence of this pathology.

Symptoms menopausal dry eyes

The first signs of a disruption in the physiological renewal of the tear film are a feeling of sand in the eyes; a desire to rub them to get rid of it; visual strain causes fatigue, especially in the evening; slight redness of the inner surface of the eyelids is visually noticeable. The symptoms are aggravated by an unfavorable environment - dry air conditioning, windy weather, the presence of contact lenses, activities associated with prolonged strain on vision. This is a mild degree of dry eye syndrome.

The average can be characterized by greater severity of symptoms. Persistent burning sensations appear, inflamed vessels of the eyelids create the impression of the constant presence of sand grains, photophobia appears, compensatory lacrimation, which intensifies outdoors in windy weather.

Severe degrees are characterized by frequent inflammation of the cornea, edges of the eyelids and the outer shell of the eye, microerosions and ulcers of the cornea, dry keratoconjunctivitis and other complications against the background of reduced immunity during the period of hormonal changes in the body.

The consequences of dry eyes are inflammatory and infectious processes that lead to changes, sometimes irreversible, in the structural components of the eyes. In addition, dry eye syndrome is one of the contraindications to laser vision correction.

Diagnostics menopausal dry eyes

With symptoms of tear film deficiency, it is necessary to consult an ophthalmologist, who, after conducting an external examination and listening to the patient's complaints, first examines the eye with a slit lamp, the design of which includes a binocular microscope in combination with a lighting system. Biomicroscopy allows you to examine the structure of the anterior eye section and detect characteristic changes in the cornea and conjunctiva.

Tests that allow assessing the level of stability of the lacrimal fluid (Norn test), total tear production (Schirmer test) and bacterioscopic examination of a smear from the conjunctiva (to clarify the presence of secondary infection) are carried out for a more complete clinical picture of the disease. Blood and lacrimal fluid tests (immunological), assessing the state of the body's protective properties and prescribing, if necessary, immunomodulatory drugs.
Crystallography of lacrimal fluid, determining the nature of the pathology - infectious and inflammatory, dystrophic process, etc.

In addition, instrumental diagnostics may be prescribed:

• fluorescein instillation test, which determines the integrity of the corneal epithelium and the nature of the tear film using a slit lamp;
• tiascopy – supplements data on the state of the tear film and the thickness of its lipid layer;
• osmometry – assesses the risk and degree of secondary evaporation and drying of the eye epithelium.

Women with climacteric syndrome are prescribed a consultation with a gynecologist, and if other dysfunctions are suspected, an endocrinologist and rheumatologist.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Differential diagnosis

Differential diagnostics are performed with the symptoms of inflammatory or degenerative ophthalmological diseases. The starting point for differentiation is that changes associated with xerophthalmia are limited to the edges of normally open eyelids.

Treatment menopausal dry eyes

Treatment of xerophthalmia is mainly reduced to the prescription of artificial tears. These drugs have a proper moisturizing effect and eliminate the symptoms of irritation from dry eyes. Pharmacies offer a wide range of tear drops with different viscosity and chemical composition, the associated infection is stopped by antibiotics in drops and ointments. The drugs and treatment regimen are prescribed by an ophthalmologist, based on the patient's medical history.

Medicines for tear replacement therapy are selected individually, taking into account the characteristics of the disease development. Drops are used in combination with hygienic procedures for the eyelids (massage, use of hypoallergenic blefagel, etc.). Containers for drops are used individually. Blurred vision may be observed immediately after instillation, which should be taken into account by patients who drive a car.

Eye drops from the Systane series have a wide range of applications; they are used three to four times a day.

Systane Ultra is intended for patients with insufficient aqueous and mucin layers. These drops are distinguished by their “intelligence” – their ingredients are selected in such a way that after instillation, the drug, adjusting to the physiological fluid of a particular patient, independently changes its consistency from liquid to jelly-like mass. This ability allows using Systane Ultra drops in the treatment of different stages of xerophthalmia. Can be used by owners of contact lenses, instilling directly onto them.

Systane Gel initially has a jelly-like consistency and, accordingly, a prolonged effect. According to patient reviews, it is more convenient to use it before bedtime. It is used at more advanced stages of corneal-conjunctival xerosis.

Systane Balance - oil-based drops, intended for people with dysfunction of the meibomian glands (insufficiency of the lipid layer of the tear film). Their action is based on sealing damage to the lipid layer, as a result of which its integrity is preserved and moisturizing substances are preserved.

The last two drugs require removing contact lenses before instillation. All types of Systane drops retain their qualities for a long time after opening the bottle (Ultra and Balance - up to six months, gel - three months).

Oxial drops are made on the basis of hyaluronic acid. The composition is close to the composition of human tears. It has a moisturizing and moisture-preserving effect, relieves symptoms of irritation and inflammation, promotes the regeneration process. Electrolytes included in the composition of the drug maintain the natural degree of mucin production. The preservative used in the composition, getting on the cornea, decomposes into inert hypoallergenic components. Instill one or two drops four to five times a day. The number of applications can be increased after consulting a doctor. Compatible with lenses of any modification.

Hilo-komod (Hilo-komod forte) drops are made on the basis of hyaluronic acid. The properties and structure of the drops are similar to human tears, in particular, the mucin layer of the tear film. It has a moisturizing and moisture-preserving effect, relieves symptoms of irritation and inflammation, promotes the regeneration process. It is used for any, even severe, degrees of dry eyes. It is recommended to instill one drop three times a day. Compatible with lenses of any modifications.

Innoxa drops (blue) is a herbal preparation based on extracts of medicinal plants. Eliminates fatigue, irritation, hyperemia, has a vasoconstrictive effect, returns the eyes to a comfortable state. Before instillation, it is necessary to remove contact lenses. Instill two or three drops in the corners of the eyes, let it soak in for about five minutes and you can put on the lenses. Use as needed. After opening the bottle, the drops can be used for half a month.

Natural tear is an absolute analogue of human tears, both in rheological and chemical properties. Removes itching, burning, hyperemia, moisturizes the cornea, replenishes the deficiency of tear film. Instill one or two drops as needed. Contact lenses must be removed before instillation. An open bottle is stored for no more than a month.

Vitamin and vitamin-mineral complexes can be useful for treating dry eyes. Women with climacteric syndrome are likely to experience a deficiency. After consulting with your doctor, you can choose the appropriate complex for yourself. It must necessarily include retinol (vitamin A), the deficiency of which is manifested by such a symptom as decreased adaptation to darkness. Vitamin C is necessary for strengthening the blood vessels of the eye, B vitamins are necessary for normalizing metabolic processes in the nervous tissue of the eye, among other things, these vitamins are characterized by high antioxidant activity. It is desirable that the complex contains vitamin E, taurine, zinc, selenium, copper and chromium.

Folk remedies

To eliminate the symptoms of corneal-conjunctival xerosis, you can use folk remedies, the simplest of which is tea lotions, known to almost everyone since childhood. Cotton pads soaked in strong tea are placed on the eyes and kept for a quarter of an hour or a little more. You can use tea bags for this. When performing this procedure, it is good to lie down, relax and remember something pleasant. If you do this in the morning and evening, you may be able to avoid the problem of "dry eye".

You can alternate tea compresses with compresses from chamomile infusion, especially since there are packaged chamomile teas on sale. First apply regular tea for about ten minutes, then chamomile.

Chamomile infusion is brewed as follows: three tablespoons of flowers are poured with a glass of boiling water. Let it brew and cool, strain and make compresses. You can use only chamomile infusion.

Therapy with ordinary clean water, according to observations, works no worse than infusions of medicinal herbs. Moreover, this method is completely safe, since herbal treatment can cause an allergic reaction. Replenishing the moisture deficit with clean water will definitely not cause side effects.

Traditional medicine suggests washing your eyes with morning dew - literally in a week all the problems will go away. However, following this advice in polluted cities is hardly reasonable, but somewhere in the country, in a recreation area, far from highways, perhaps you can try.

Honey poultices: dissolve a teaspoon of honey in three tablespoons of water and make poultices two or three times. Each time you need to prepare a fresh composition.

Simple gymnastics that can be done more often, such as blinking frequently or rotating your eyes clockwise and then counter-clockwise, will be suitable as a therapy for dry eye syndrome. Move your eyeballs from side to side without turning your head, holding them briefly in the extreme position. You can alternate these exercises.

Homeopathy

Oculoheel is a homeopathic eye drop that relieves pain and inflammation and is active against infectious agents. It normalizes trophic processes in the eyes and muscle tone. The active ingredients are homeopathic dilutions of medicinal plants. It can be used to normalize the condition of the eyes under high loads that cause lacrimation disorders and irritation symptoms. The recommended dosage is two drops three times a day. An opened capsule should not be stored for more than 24 hours.

DreamTeam MagicEye™ – energy-informational homeopathic drops, produced in Russia. The active component is sterile water, which carries a “health matrix” (information of healthy eyes) at the cellular level. This is a medicine of the future, stimulating healing and normalization of intracellular and intercellular processes. All this is accomplished by water, with the help of the information spectrum of healthy eye cells recorded on it. When dropped into the eyes, it itself finds pathologies and restores the normal state with the help of the “health matrix”.

Classical homeopathy offers the following medications:

• relieving eye fatigue when reading, working at a computer monitor, and other visual stress – Fagopyrum, Heracleum sphondylium;
• if you feel dryness, burning, or fog in your eyes – Senega (Senega);
• One of the best drugs that eliminates excessive lacrimation, photophobia, and blurred vision is Conium.

Surgical treatment

Surgical intervention to block the tear fluid flowing out of the eye is used in extreme cases, if drug therapy does not give positive results or the need for instillation occurs too often. In this case, the tear outflow is blocked with silicone occluders - creating a mechanical barrier for the tear in order to cover its deficiency. Before permanently blocking the tear canals, they are temporarily blocked with absorbable collagen tampons. The expediency of the operation is confirmed by a decrease in the symptoms of "dry eyes", in this case the tear drainage paths are blocked with permanent occluders.

In the treatment of complications of corneal-conjunctival xerosis - xerotic ulcers, corneal perforation, etc., surgical treatment is also often used.

Prevention

Women in menopause lead the risk group for xerophthalmia. To prevent the disease, you need to follow simple rules:

• drink enough fluids, preferably clean water;
• follow a diet containing vitamins A, B, C, E, and microelements;
• protect your eyes from direct sunlight (wear high-quality sun-protective glasses, wide-brimmed hats, and visors);
• humidify the air in rooms, especially with electrical appliances, try to avoid dusty and smoky rooms;
• For contact lens wearers and office workers who spend a lot of time at the computer, use moisturizing eye drops for preventive purposes;
• take technological breaks during work, do gymnastic exercises for the eyes.

If you feel that symptoms of dry eyes appear, consult a doctor without delay. Timely diagnosis and treatment of xerophthalmia significantly improves the condition, reduces the likelihood of complications that can lead to serious consequences for vision and surgical interventions.

Forecast

Most patients who visit an ophthalmologist during menopause complaining of dry eyes have a mild or moderate degree of the disease. Their treatment consists of replacing the lack of tear fluid and stabilizing the tear film, which is successfully done by tear substitutes. Almost always, the prognosis for maintaining the patient's visual functions is quite favorable.

[ 7 ], [ 8 ]