Why Chronic Dry Eye is More Common in Women

Research shows that twice as many women as men have chronic dry eye (CDE). Plus, women are diagnosed earlier and have worse symptoms.¹

Though the eyes of men and women look the same, there are genetic differences between them. These differences may lead to high rates of CDE in women. Different behaviors may also raise the risk of CDE.¹

Gender is a risk factor

Several studies have looked at the link between gender and CDE. While each study had varied statistics due to the way they were set up, they all show higher rates of CDE for women than men. These findings show that gender is a risk factor for dry eye:¹

• Beaver Dam Offspring Study (2014) – 17.9 percent of women versus 10.5 percent of men had CDE in the 2014 Beaver Dam Offspring Study
• U.S. National Health and Wellness Survey (2017) – 2.9 percent of women ages 18 to 34 had CDE versus 2.6 percent of men in the same age group. For those 75 and older, 22.8 percent of women had dry eye versus 12.6 percent of men.
• U.S. Department of Defense Military Health System (2017) – 7.8 percent of women had dry eye versus 3 percent of men. For those 18 to 39, 3.1 percent of women had dry eye versus 1.3 percent of men. For those 50 and older, 15.9 percent of women had dry eye versus 7 percent of men.

These studies also showed that the average age at diagnosis is 60 years old for women. It is 66 years old for men.¹

Why do women have a higher risk?

Men and women have different genetics and hormones. These cause differences in eye shape and function, which raise your risk. Certain behaviors also raise your risk.¹

Genetics

High levels of a protein called transglutaminase 1 (TGase1) are linked to eye diseases. TGase1 is one of many proteins affecting eye health. A 2019 study showed women have twice as much TGase1 as men. This may be 1 factor that leads to CDE.^1,2

Hormones

Researchers have found that low levels of androgens raise the risk of CDE. Androgens are hormones that contribute to growth and reproduction in both men and women. Big changes in hormone levels are another a risk factor. In women, big changes occur during menstruation, pregnancy, and menopause.^1,3

Birth control pills and hormone replacement therapy (HRT) also cause CDE. Birth control lowers androgens like testosterone. A 2019 study showed estrogen HRT raises chronic dry eye risk by 70 percent. Estrogen plus progesterone/progestin raises the risk by 30 percent. For every 3 years HRT is used, the risk rises 15 percent.^1,3

Behaviors that increase CDE risk

Some behaviors that impact eye health are more common in women than men. Some of the side effects of these behaviors and procedures include fewer tears and less blinking. These risk-raising behaviors include:¹

• Having LASIK surgery
• Undergoing cosmetic surgery for the eyelids (blepharoplasty)
• Getting Botox shots for wrinkles
• Wearing contact lenses
• Getting permanent makeup
• Using makeup and face creams such as mascara, eyeliner, anti-aging creams, and makeup remover
• Taking certain drugs like antihistamines, multivitamins, antidepressants and antipsychotics

Autoimmune diseases and dry eye

Autoimmune diseases are more common in women. Many cause inflammation, which may trigger CDE. Autoimmune diseases linked to dry eye include:¹

• Sjögren’s syndrome
• Lupus
• Rheumatoid arthritis
• Thyroid problems like Graves’ disease and Hashimoto’s disease

A change in eye health may be the first sign an autoimmune disease is worsening. Regular visits to your eye doctor may help manage your autoimmune disease and reduce your risk of CDE.¹

Other health factors

Research shows that other health factors play a role in CDE. A comorbidity is a condition you have at the same time as a second or third disease. A 2019 study found these CDE comorbidities exist for women but not men:¹

• Thyroid disease
• Depression
• Diabetes (for women under 65)
• Headaches/migraine (for women 65 and older)
• Anxiety (for women 65 and older)

How can I lower my risk?

Chronic dry eye affects more than your eyes. Compared to women without CDE, those with the condition get poorer sleep. Good sleep is important for your health. Lowering your risk for CDE may improve your quality of life. You can lessen your risk by:^1,4,5

• Being aware of high-risk behaviors and how they affect your eyes
• Using a humidifier in dry, windy regions
• Asking your doctor about eye drops
• Avoiding eyeliner on your inner eyelids
• Washing your face nightly with soap or paraben-free makeup remover
• Wearing sunglasses
• Seeing your eye doctor often