Women experience dry eye at significantly higher rates than men—but the reasons extend far beyond age or screen time. In this episode of The 20/20 Podcast, Dr. Harbir Sian sits down with Dr. Janice Luk to explore the often-overlooked connection between women’s health, hormonal changes, beauty routines, and ocular surface disease. From birth control and pregnancy to perimenopause and menopause, Dr. Luk explains how fluctuations in estrogen, progesterone, and androgens may influence meibomian gland function, tear-film stability, inflammation, and dry-eye symptoms.

The conversation also examines how optometrists can address makeup, lash extensions, lash lifts, and other beauty treatments without simply telling patients to stop doing the things that matter to them. Dr. Luk shares practical questions clinicians can ask, strategies for maintaining eyelid and lash hygiene, and ways to build trust through collaborative patient education. The episode concludes with a discussion of the evolving TFOS DEWS III approach to dry-eye management, the value of introducing multiple treatment modalities earlier, and the role of immunomodulatory therapies in reducing inflammation and improving patients’ comfort and quality of life.

3 Key Takeaways

1. Hormonal health should be part of the dry-eye conversation.

Hormonal fluctuations throughout a woman’s life—including those associated with oral contraceptives, pregnancy, perimenopause, menopause, and hormone-replacement therapy—may affect the ocular surface. Asking thoughtful questions about hormonal changes can help uncover contributing factors that patients may not realize are connected to their eye symptoms.

2. Beauty routines should be discussed, not dismissed.

Rather than simply advising patients to stop wearing makeup or getting lash treatments, optometrists can help them make safer choices. Asking about makeup removal, lash-extension cleaning, product ingredients, and eye discomfort can protect ocular health while respecting the patient’s lifestyle and identity.

3. Dry-eye treatment is becoming more integrated and proactive.

The newer TFOS DEWS III framework moves away from a rigid, step-by-step treatment ladder and encourages clinicians to consider the whole patient and introduce complementary therapies earlier. Addressing inflammation promptly—with prescription medications, at-home care, in-office procedures, or other appropriate options—may lead to faster and more meaningful improvement.

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