Impact of menopause on dry eye disease: a cross-sectional comparative study

Post-menopausal women frequently experience ocular dryness, with a notably greater severity of clinical symptoms and signs. Despite the high burden of dry eye disease in this population, limited evidence exists regarding the underlying nature and characteristics of this condition.

In this cross-sectional comparative study, 319 participants were enrolled: 102 post-menopausal women, 105 age-matched men, and 112 younger healthy females. Assessments included the Ocular Surface Disease Index (OSDI), tear breakup time, corneal and conjunctival staining, Schirmer's test, and meibomian gland evaluations. Severity was classified using established clinical criteria. Multivariable logistic regression was performed to identify predictors of severe DED.

Post-menopausal women exhibited significantly higher mean OSDI scores (24.1 ± 16.5) compared to age-matched men (20.2 ± 16.7) and younger females (19.8 ± 15.3; p = 0.043). They also had notably shorter TBUT, greater ocular surface staining, and more pronounced meibomian gland dysfunction. Burning (20.6%) and itching were more frequent in this group (p < 0.05). Severe DED prevalence was highest among post-menopausal women (24.5%), versus age-matched men (16.2%) and younger females (18.8%; p = 0.047). Multivariable regression analysis identified burning symptoms as a significant predictor of severe DED (OR ∼ 2.40), while post-menopausal status (OR ∼ 1.19) and lid-margin changes (OR ∼ 1.42) showed weaker associations.

DED in post-menopausal women is more severe and predominantly exhibits an evaporative profile, characterised by tear film instability and meibomian gland dysfunction.