3 6 O P T I C A L P R I S M | M A R C H 2 0 2 6
O P T I C A L I N S I G H T S
3 6 O P T I C A L P R I S M | M A R C H 2 0 2 6
There have been a few reported cases of
pregnant women experiencing minor losses
in their peripheral vision for a short period
of time.
Women can also suffer from pregnan-
cy-induced dry eye. This can be intensified
with contact lens wear. Artificial tear
supplements can be used to minimize these
symptoms. Some women need to be refitted
with different contact lenses that are more
suited for dry eye conditions.
Corneal thickness generally increases
during pregnancy, particularly in the second
and third trimesters. Research suggests a
3.1% increase in central corneal thickness
during the third trimester.
visual disturbances like hallucinations or
illusions. These, often temporary, ocular
symptoms may include blurred vision and
increased photophobia due to the impact of
hormone-induced changes on the cornea.
IVF-related dry eye is sometimes caused by
elevated estrogen levels resulting in signifi-
cant tear film alterations.
In addition, hormonal fluctuations can cause
the cornea to temporarily change shape or
thickness, leading to blurred vision.
Illusory palinopsia may occur in rare cases.
This is a rare, temporary, and disturbing
phenomenon where images persist or appear
in the visual field (afterimages) due to high
estrogen levels affecting the visual cortex.
Unfortunately, eye symptoms associated
with menopause are easily dismissed, stated
Dr. Daniel Reisel, Specialist Registrar in
Obstetrics and Gynecology at University
College Hospital London. “Often people
say, ‘Oh, it’s just age.’ But because hormones
go everywhere in the body, menopause can
affect every organ system and every cell type,
including mucous membranes, skin, hair and
brain tissue. And, yes, glands in your eyes are
also affected.”
Reisel stated, however, that this is not well
recognized, even among GPs. “There’s this
cliché that menopause is just hot flushes,
but really it’s much more like a menopause
industrial complex.”
Meibomian gland dysfunction is known
to play a significant role in the ocular
symptoms of menopause. The tears of the
eyes are made of three layers: water, oil and
mucus. When hormones decrease in peri-
menopause and menopause, the oil layer in
tears is impacted. Tears become unstable
and evaporate too quickly.
The glands that produce the oil layer of the
tears, the meibomian glands, are impact-
ed by the drop in the hormones estrogen,
progesterone and testosterone that starts as
a woman enters perimenopause. This causes
less oil volume and lower oil quality in tears.
When the oil layer is low, tears evaporate
too quickly. Any time that blinking is
reduced, such as when someone looks at
screens for an extended period of time, dry
eye symptoms will worsen. Similarly, if the
oil layer of tears is compromised, being out-
side in cold or windy conditions will make
the eyes feel dry or cause over-tearing. Even
during sleep, eyes can become dry. This can
mean dry eyes overnight or dry, blurry eyes
first thing in the morning.
No matter which phase of life your female
patients are in, they’re susceptible to the
effects of hormone fluctuations and
changes. ECPs can support these patients
by encouraging them to report these events
as quickly as possible so that appropriate
treatment or referrals can be provided.
Patients may also experience emotional
effects related to hormonal shifts, in which
case professional counselling – or even just
a listening ear – can be helpful. OP
One study reported, on average, a 16-micron
increase compared to postpartum controls.
While most studies report a temporary
increase in central corneal thickness, these
changes usually resolve three months
postpartum.
The thickening is attributed to physiolog-
ical water retention (edema) and hormo-
nal shifts (estrogen, progesterone) that
affect ocular tissues. These changes are
temporary, with measurements typically
returning to baseline three months after
delivery. However, it’s important to note
that not all research finds a statistically
significant change in corneal thickness
during pregnancy.
IVF TREATMENTS: IVF involves high
hormonal changes, particularly increased
estrogen, which can cause temporary
vision changes, dry eye and, in rare cases,
Corneal changes due to the high hormone
influx during IVF can weaken or alter the
cornea, which may worsen pre-existing
conditions like keratoconus.
Retinal risk: Some studies suggest a higher
long-term risk for retinal detachment
in women who have undergone fertility
treatments.
MENOPAUSE: For some women, the
years leading up to “the golden years” are
not so golden. Dry eye frequently occurs
during the menopausal years, and glaucoma
and cataracts may also develop. According
to Dr. Lauren Gormley, OD at Johns
Hopkins Medicine, dry eyes and the hor-
mones associated with a woman’s menstrual
cycle are related. More than half of women
will develop symptoms associated with
dry eyes as their menstruation slows and
eventually stops as they begin menopause.
MEIBOMIAN
GLAND DYSFUNCTION
IS KNOWN TO PLAY A
SIGNIFICANT ROLE
IN THE OCULAR SYMPTOMS
OF MENOPAUSE.”