On Wednesday, June 17 at the American Optometric Association's 2026 Optometry’s Meeting in Phoenix, Mila Ioussifova, OD, CNS, FAAO, FOWNS; Hardeep Kataria, OD, FAAO; and Ada Noh, OD, gave an informative presentation titled “Dry Eye in Women: Hormonal and Aesthetic Considerations.” The overarching theme of the presentation was that hormonal changes and aesthetic practice are underrecognized contributors to dry eye in women. Successful diagnosis and management require looking beyond traditional dry eye risk factors and incorporating hormonal history, cosmetic habits, and interdisciplinary care into routine clinical practice. 

Here are 5 key takeaways from the presentation:

1. Women are disproportionately affected by dry eye disease (DED). Women are 2x more likely than men to develop clinically significant DED, and almost two-thirds of patients seeking care for dry eye are women.

2. Hormonal influences are a major driver. Declining estrogen, progesterone, and androgen levels during perimenopause contribute to meibomian gland dysfunction, inflammation, and both evaporative and aqueous-deficient dry eye. Testosterone and the balance of related hormones support meibomian gland function, lipid production, and lacrimal gland health. Deficiency is strongly linked to evaporative dry eye, particularly in postmenopausal women and those who have Sjögren syndrome.

3. Cosmetics and beauty practices can significantly worsen ocular surface disease. Tightlining eyeliner, waterproof makeup, heavy concealers, eyelash extensions, lash serums, and tattoo eyeliner can obstruct meibomian glands, destabilize the tear film, and increase inflammation. In addition, Botox can impair blink mechanics, causing tear-film instability, exposure keratopathy, and evaporative dry eye. Fillers and other periorbital procedures may also affect ocular surface health. 

4. A gender-sensitive history improves diagnostic accuracy. Clinicians should routinely ask about hormone therapy, menstrual cycle status, pregnancy, menopause, cosmetics, lash treatments, Botox, skincare products, and lifestyle factors because these frequently explain symptoms and treatment failures. Meibography, tear osmolarity, MMP-9 testing, blink analysis, and eyelid evaluation are particularly useful because hormonal status and cosmetic use can significantly affect test results and disease presentation. 

5. Management should be personalized and hormone-aware. Treatment strategies should vary by life stage. Recommendations include preservative-free lubricants, anti-inflammatory therapies, omega-3 supplementation, meibomian gland support, and cosmetic-safe eyecare practices. Collaboration with OB-GYNs, rheumatologists, dermatologists, and aesthetic providers may be necessary.OM