Pregnancy frequently causes or exacerbates the symptoms of dry eye syndrome, a condition where the eyes do not produce enough tears or the tears evaporate too quickly. This is a common physiological side effect of the significant hormonal shifts that occur. The balance of the tear film, which provides lubrication and protection to the eye’s surface, becomes disrupted. Dry eye is estimated to affect between 20% and 50% of pregnant women, most often occurring during the second and third trimesters.
How Hormones Affect Tear Production
Elevated levels of estrogen and progesterone directly influence the glands responsible for tear production and stability. The tear film has three layers—oil, water, and mucus—and pregnancy hormones can alter its composition. This disruption leads to increased tear evaporation, a common mechanism of dryness.
The meibomian glands, located along the edges of the eyelids, produce the outermost oil layer (meibum). This oily layer prevents the watery layer of the tear film from evaporating too quickly. Hormonal fluctuations can impair meibomian gland function, decreasing the quality of the protective oil they secrete.
Estrogen is thought to promote inflammation on the ocular surface and may decrease the quality of meibomian gland secretions. A change in the balance of sex hormones, including reduced androgens, can lead to meibomian gland dysfunction and evaporative dry eye. These hormonal changes also reduce the tear fluid quantity produced by the lacrimal glands.
Identifying Signs of Ocular Dryness
Dry eyes during pregnancy manifest as several uncomfortable symptoms. A common sensation is a feeling of grittiness or sand in the eye, along with a persistent foreign body sensation. Individuals may also notice a burning, stinging, or aching feeling.
Increased sensitivity to light (photophobia) can become noticeable, especially in bright environments. Vision may temporarily blur or fluctuate, which is bothersome when focusing on screens or reading. Ironically, the eye may sometimes water excessively as an irritated response to the underlying dryness.
Safe Relief Strategies During Pregnancy
The safest first-line treatment for managing dry eye symptoms involves using lubricating eye drops, commonly called artificial tears. Preservative-free artificial tears are recommended because they minimize potential irritation or toxicity associated with common preservatives. These drops can be applied as needed throughout the day to supplement natural moisture.
Environmental Modifications
Modifying the environment can provide relief. Using a humidifier helps add moisture to the air and reduce tear evaporation, especially in dry climates or during winter. Avoid direct exposure to air conditioning vents, fans, or car heaters, as these quickly dry out the ocular surface.
Lifestyle Adjustments
Proper hydration is important, as drinking plenty of water supports overall moisture balance, including tear volume. For individuals who wear contact lenses, increased dryness can cause significant discomfort and intolerance. Switching to glasses temporarily is often recommended, as this removes a factor that can exacerbate dryness. Applying a warm compress to the eyelids daily can help improve the flow of oil from the meibomian glands, stabilizing the tear film.
Postpartum Resolution and Outlook
Dry eye symptoms related to pregnancy are typically temporary and often resolve after delivery as hormone levels begin to normalize. Most women experience significant improvement in eye comfort within a few weeks to a few months postpartum. However, if individuals choose to breastfeed, symptoms may persist or be exacerbated until nursing stops, as the hormonal environment remains altered.
While most cases are manageable, it is important to know when to seek professional help. Severe symptoms like intense, persistent eye pain, sudden changes in vision, or an increase in floaters or flashing lights require immediate consultation with an eye care professional or an obstetrician. These signs must be evaluated to rule out other conditions like preeclampsia or corneal complications, which require specific medical management.