Could Hormone Imbalance Be Causing Your Dry Eye?
Author: Dr. Kim Raharja, OD
If your eyes are constantly dry, burning, irritated, or watery, the problem may be more than a lack of tears.
You have probably tried artificial tears. Maybe you've used warm compresses, eyelid wipes, prescription eye drops, or other dry-eye treatments.
But what if your eyes still don't feel right?
The problem may not simply be that you need more moisture. Your hormones could be a key factor, helping you feel more in control of your eye health.
Your Eyes Need Healthy Oils, Not Just Tears
Your tears have several layers, including an important oily layer produced by tiny glands in your eyelids called the meibomian glands.
These glands help keep your tears from evaporating too quickly.
When the glands don't function properly, your tears can disappear faster than they should. This can cause:
Burning or stinging
Gritty or sandy eyes
Fluctuating vision
Redness and irritation
Watery eyes
Contact lens discomfort
Eye fatigue
Symptoms that are worse with screens, reading, or driving
This is called evaporative dry eye, and meibomian gland dysfunction is one of its most common causes.
What Do Hormones Have to Do With Dry Eye?
Your meibomian glands are influenced by hormones called androgens, including testosterone.
As we age or experience hormonal changes, androgen activity can change. For some people, this may affect the quality and function of the oils the meibomian glands produce.
This is one reason a patient can have significant dry-eye symptoms even when they are producing an adequate amount of tears.
Sometimes the question isn't, "How can we put more tears in the eye?"
The better question may be:
"Why aren't my eyes keeping their tears healthy and stable?"
Could Testosterone Help?
Researchers are actively exploring androgen-based treatments, including testosterone, which may offer new hope for supporting your eye health. One side effect of taking systemic testosterone is oily skin and acne. There are many androgen receptors on the meibomian gland itself. It makes sense that a testosterone eye drop could stimulate the meibomian glands and encourage more oil secretion.
Early research has shown promising improvements in tear-film stability, meibomian gland function, and dry-eye symptoms. However, testosterone treatment for dry eye is still an emerging area of care, and more research is needed.
One challenge is that compounded testosterone eye drops can be difficult to obtain because not every compounding pharmacy is equipped to prepare them.
That has led to interest in another hormone pathway, DHEA.
What Is DHEA?
DHEA, or dehydroepiandrosterone, is a naturally occurring hormone precursor to testosterone.
Think of DHEA as a building block in the body's androgen pathway.
Your body can convert DHEA through several enzymatic steps into other hormones, including androgens such as testosterone.
DHEA is a precursor to testosterone.
For this reason, DHEA may provide a more gradual approach to supporting androgen activity.
Why Is This Important for Dry Eye?
If your dry eye is partly related to reduced androgen activity or poor meibomian gland function, supporting this pathway may be another piece of your treatment plan.
It does not replace other dry-eye treatments. Instead, it may address another pathway contributing to dry eyes.
That matters because dry eye is rarely caused by just one thing.
Could Hormones Be Part of Your Dry Eye?
If you've been treating dry eye but continue to struggle with symptoms, it may be worth looking deeper.
A comprehensive dry-eye evaluation can help identify which pathways contribute to your symptoms, rather than simply treating them with another bottle of artificial tears.
At Atlanta Eye Associates, we evaluate your tear film, meibomian glands, eyelids, ocular surface, and other potential contributors to dry eye.
When appropriate, we can also consider whether hormonal and androgen pathways may be relevant to your individual treatment plan, ensuring personalized care.
Your Dry Eye May Have a Bigger Story.
If you've tried treatment after treatment and your eyes still don't feel normal, don't assume that you just have to live with dry eye.
Another reason may be that your eyes from maintaining a healthy tear film.
Sometimes the key to treating dry eye is not adding more tears. It is finding out why your eyes can't keep them.
Hormonal therapies such as DHEA or compounded testosterone eye drops are not appropriate for everyone and should only be considered following an individualized medical evaluation. Testosterone ophthalmic therapy is an emerging area of dry-eye treatment.
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