Nishi Mehdiratta, OD, knows that treating dry eye in menopausal patients requires looking well beyond artificial tears. For her, it starts with a conversation—one that many patients have waited years to have.
“There’s always a look of relief when I bring up dry eye symptoms,” says Dr. Mehdiratta, owner of Luxe Eye Care in Houston. “Patients often tell me they’ve been told to ‘just live with it’ because it’s part of menopause. Some feel they’ve been gaslit. It’s important to acknowledge what they’re experiencing.”
That longing to be heard has fueled Dr. Mehdiratta’s passion for hormonal dry eye, an area she believes deserves more attention within optometry. While she has built a niche for her practice in treating these patients, she emphasizes that optometrists don’t need specialized training to start helping their patients.
“The training we already have is more than adequate,” she says. “The biggest hurdle is simply becoming comfortable enough to start the conversation.”
SIGNS HIDING IN PLAIN SIGHT
Many of Dr. Mehdiratta’s menopausal patients are not seeking dry eye treatment. instead, they come in for routine eye exams, often unaware that their symptoms are connected to hormonal changes.
Fluctuating vision, burning, tearing, contact lens intolerance and chronic redness are all common complaints. Excessive tearing is especially counterintuitive, as many patients don’t realize watery eyes can actually signal dry eye.
“I ask questions about symptoms that worsen throughout the day, morning redness and difficulty with prolonged screen use,” she says. “A lot of the time, their answers reveal a pattern that points back to menopause.”
Research shows that more than 60% of women experience dry eye symptoms during peri- and postmenopause. Dr. Mehdiratta believes the true number is even higher. Hormonal changes affect the ocular surface in several ways. Declining androgen levels reduce lipid production, contributing to meibomian gland dysfunction. Lower estrogen and progesterone levels affect tear stability and increase inflammation.
The result, she says, is often a patient who has undergone multiple prescription checks and remains frustrated by fluctuating vision.
“It’s never been about the prescription,” she says. “It’s the ocular surface.”
MOVING BEYOND THE BAND-AID APPROACH
One of the most common misconceptions Dr. Mehdiratta encounters is the belief that artificial tears are enough.
“Artificial tears may provide temporary relief, but they don’t address the underlying inflammation or meibomian gland dysfunction,” she says.
Some patients tell her they use drops every 15 minutes just to stay comfortable, to which she often says, “No one should have to live like that!”
She encourages optometrists to evaluate where patients are in the progression of ocular surface disease and tailor treatment accordingly. Omega-3 supplementation, hypochlorous acid and anti-inflammatory at-home regimens can play important supporting roles, but she notes that they are rarely standalone solutions.
Because inflammation drives much of hormonal dry eye, many of her patients require in-office treatments, including intense pulsed light therapy. The goal, she says, is to intervene early.
“These symptoms are only going to become more severe as hormone levels continue to decline,” she says. “We need to be proactive instead of reactive.”
BUILDING BRIDGES WITH REPRODUCTIVE HEALTH SERVICES
Located just minutes from Houston’s Texas Medical Center—the largest medical complex in the world—Dr. Mehdiratta saw an opportunity to educate physicians outside of optometry.
Through grassroots networking, she and her staff connected with menopause-focused gynecology clinics within Texas Medical Center and offered educational presentations on the ocular effects of menopause.
Those relationships have evolved into a two-way referral network. “When I tell patients I can refer them to a clinic that specializes in menopause, they’re thrilled,” she says. “They feel like someone finally understands what they’re going through.”
Collaborating with gynecologists has also given Dr. Mehdiratta a deeper understanding of hormonal changes and hormone replacement therapy (HRT), prompting her own educational journey into androgens, estrogen, progesterone and HRT.
VALIDATION CHANGES EVERYTHING
Perhaps the most striking pattern Dr. Mehdiratta sees is that her patients rarely bring up menopause themselves; she almost always initiates the discussion.
When she observes signs of inflammation and asks whether a patient is peri- or postmenopausal, she says the response is remarkably consistent.
“Their eyes get wide, and they say, ‘Yes. How did you know?’”
That moment often leads to a larger conversation about symptoms patients have quietly accepted. “Why are we not talking about these things?” she asks. “Let’s make it commonplace.”
She hopes more ODs—both male and female—will feel comfortable addressing hormonal changes with patients, given their direct impact on the ocular surface.
“Women want to talk about it,” she says. “They want to feel heard. They want validation that these symptoms can indeed be debilitating.” For Dr. Mehdiratta, that validation is what makes this work so rewarding.
“When a patient tells me that for the first time in 10 years they haven’t thought about their eyes all day, I feel like I’ve done my job,” she says. “You can change lives if you just take the time to hear them out.”
