Lately, your eyes have been bothering you. They tear up for no reason. They ache after reading for a while. You reach for eye drops more often than you used to, and they seem to do less than they did before. You have been putting it down to tiredness, or the air-conditioning, or simply getting older.
You might be right about the last part. Dry eye syndrome does become more common and more persistent as we age, and it affects both men and women. But getting older does not mean you have to accept the discomfort. The reasons dry eye worsens with age are well understood, and they are more treatable than most people realise.
Here is what is actually happening, and what you can do about it.
Your Tear-Producing Glands Change With Age
Tears are more complex than they appear. They are made up of three distinct layers: an outer oily layer that prevents evaporation, a middle watery layer that keeps the eye surface hydrated, and an inner layer of mucin that helps tears spread evenly across the cornea. Each layer is produced by a different set of glands, and each of these glands is affected by the ageing process.
Research involving over 60,000 individuals found that people aged 60 and above have a 31% higher risk of developing dry eye disease than younger adults. The key changes involve two glands in particular. The lacrimal gland, which produces the watery component of tears, gradually loses function over time, producing less volume and lower-quality tears. The meibomian glands, which line the edges of the eyelids and produce the oily layer, become increasingly prone to dysfunction with age, meaning the tear film evaporates more quickly than it should.
Studies show that signs of meibomian gland dysfunction can begin appearing in adults as early as their mid-twenties, while the more significant aqueous deficiency associated with aging typically becomes clinically apparent from the late forties onwards. By the time most people reach their sixties, these changes in tear quality and production are well established.
The result is a tear film that is thinner, less stable, and quicker to break down. Even small disruptions, a long car journey, a cold room, or a few hours with a book, can tip the balance into noticeable discomfort.
Signs that ageing may be affecting your tear film:
- Eyes feel fine when you wake up but become uncomfortable later in the day
- Watery eyes, particularly outdoors or in air-conditioned spaces (the eye producing reflex tears in response to dryness)
- Vision that fluctuates, then clears when you blink
- Sensitivity to light or air-conditioned spaces that did not bother you before
The Hormonal Connection: Why It Affects Both Men and Women
Hormonal changes are one of the most significant and underrecognised drivers of dry eye in older adults. And this is not just a story about women and menopause, though menopause does play a significant role.
Androgens are hormones present in both men and women that play a direct role in regulating the meibomian glands. Research has confirmed that androgen receptors are present in the meibomian glands, and that androgens actively stimulate the production of the lipid component of tears. When androgen levels decline, as they do in both sexes with age, the quality and quantity of that oily layer deteriorates.
For women, this process accelerates around menopause. Studies have found that women over 50 have nearly double the rate of dry eye disease compared to men in the same age group. Research specifically examining perimenopausal and postmenopausal women found a notably high prevalence of dry eye linked directly to hormonal shifts, with improvements seen in women who received hormone therapy that included androgen support.
For men, the decline in androgens is more gradual but equally real. Men who take medications that block androgen activity, for conditions such as prostate issues, are significantly more likely to develop dry eye and meibomian gland dysfunction, confirming the direct link between androgen levels and eye health.
The practical takeaway is that if your dry eyes worsened noticeably around a hormonal transition, whether menopause for women or simply midlife for men, that timing is likely not a coincidence.
Hormonal dry eye may be a factor if:
- Symptoms worsened noticeably around menopause or mid-fifties
- You take medications that affect hormone levels
- Discomfort is particularly associated with the quality of tears rather than the volume (watery eyes despite feeling dry)
- Standard lubricating drops provide only brief relief
The Medication Question Many People Do Not Think to Ask
One of the most overlooked contributors to dry eye in older adults is the medication cabinet.
As we age, many of us take more medications for more conditions. Blood pressure, cholesterol, sleep, mood, allergy relief. This is entirely understandable. But research has consistently identified several common medication classes as contributors to dry eye disease, including antihistamines, antidepressants, diuretics, and certain blood pressure medications. These drugs can reduce tear production, alter the stability of the tear film, or affect the glands responsible for tear quality.
A large study of over 500 patients with moderate to severe dry eye found significantly worse symptoms in users of antihistamines and corticosteroids compared to non-users. Research also shows that medication side effects are estimated to be three times more pronounced in older adults than in younger patients, and that the complexity of interactions between multiple medications increases with every additional drug added to the regimen.
This does not mean you should stop taking medications your doctor has prescribed. It means that if your dry eye has worsened around the time a new medication was introduced, that connection is worth raising with your eye specialist and your prescribing doctor together.
Worth reviewing with your doctor if:
- Dry eye symptoms worsened after starting a new medication
- You take antihistamines regularly, including over-the-counter allergy relief
- You use multiple medications daily and have not discussed their eye-related effects
- Eye drops provide short-term relief, but symptoms return quickly
When Watery Eyes Actually Mean Dry Eyes
One of the most confusing aspects of dry eye in older adults is this: the eyes can be producing too little of the right kind of tears while simultaneously appearing to be constantly watering.
This happens because the eye surface, when chronically under-lubricated, triggers a reflex response. The lacrimal gland is prompted to produce a sudden flood of tears to protect the irritated surface. These reflex tears are watery and unstable. They do not have the oil layer that prevents evaporation, so they do not actually resolve the underlying dryness. They simply spill over.
Many older adults describe this as an annoyance, wiping their eyes constantly, especially outdoors or in cold air, without realising it is a sign that their eyes are not getting adequate baseline lubrication. If your eyes water in the wind during your morning walk along the reservoir, or well up unexpectedly during a meal, this is something worth mentioning at your next eye examination.
Signs this may apply to you:
- Eyes water frequently, especially outdoors, in air-conditioning, or in the wind
- Tearing is worse in cold or dry environments, but you do not have allergies
- Eyes feel dry and heavy even when they appear wet
- Over-the-counter drops help briefly but the watering returns
Dry Eye Treatment for Older Adults Is Not One-Size-Fits-All
The most important thing to understand about managing dry eyes in older adults is that what worked at 35 is unlikely to be sufficient at 55 or 65. The underlying cause has changed, and the treatment approach must reflect that.
A proper dry eye assessment for an older adult goes beyond a quick look with a torch. It involves evaluating the quality and quantity of tear production, examining the meibomian glands along the eyelid margins, assessing the tear film’s stability and its oily layer, and reviewing medications and systemic health conditions that may be contributing.
Depending on the findings, treatment may include preservative-free lubricating drops specifically selected for your tear type, prescription anti-inflammatory eye drops to address the chronic low-grade inflammation that characterises age-related dry eye, punctal plugs to conserve the tears you do produce, or oral omega-3 supplementation to support the quality of meibomian gland secretions.
The right combination depends on your specific dry eye pattern. This is why self-managing with pharmacy drops for years can feel like running in place. You may be treating a symptom while the underlying cause, hormonal, glandular, or medication-related, continues unchecked.
Expert Dry Eye Care at Angel Eye and Cataract Centre
At Angel Eye and Cataract Centre, we understand that dry eye in older adults is a different clinical picture from the screen-related dryness seen in younger patients. Dr Allan Fong brings extensive experience evaluating and treating age-related dry eye syndrome, including cases involving hormonal factors, meibomian gland dysfunction, and medication-related contributors.
Every patient begins with a comprehensive assessment, not a prescription based on symptoms alone. We examine the health of the tear film, the meibomian glands, and the ocular surface in detail before building a treatment plan that addresses the specific cause of your dry eye rather than just the discomfort it produces. This may include:
- BlephEx — a gentle in-clinic eyelid clean that removes the bacteria and debris that accumulate along the eyelid margins over the years. As we age, this build-up quietly worsens dry eye — and no amount of home cleaning gets rid of it properly
- Expansione My Mask — an in-clinic treatment combining heat and light therapy to unblock eyelid glands and calm inflammation. For older adults whose glands have naturally slowed down, this helps restore the oil layer that keeps tears stable and eyes comfortable
Take the Next Step
Those watery eyes at the end of the day. The discomfort during your evening walk. The drops you apply three times before bed. You have adapted around the problem long enough.
Contact Angel Eye and Cataract Centre today to schedule a comprehensive dry eye treatment consultation in Singapore. Because getting older does not mean accepting discomfort. It means understanding it and finding the right answers.
Medical References
- Hashemi H, et al. (2022). Impact of Aging on the Pathophysiology of Dry Eye Disease: A Systematic Review and Meta-Analysis. Ocular Surface, 25:36-48. PMID: 35753664.
- Wang MTM, et al. (2020). Ageing and the Natural History of Dry Eye Disease: A Prospective Registry-Based Cross-Sectional Study. Contact Lens and Anterior Eye. PMID: 32758530.
- Gedde MM, Akpek EK. (2014). Aging: A Predisposition to Dry Eyes. Journal of Ophthalmology. PMC4150485.
- Giannaccare G, et al. (2022). Is Dry Eye Disease the Same in Young and Old Patients? BMC Ophthalmology. PMC8861619.
- Murube J. (2017). Dry Eye Syndrome in Menopause and Perimenopausal Age Group. Journal of Mid-life Health. PMC5496280.
- Sullivan DA, et al. (2002). Androgen Deficiency, Meibomian Gland Dysfunction, and Evaporative Dry Eye. Annals of the New York Academy of Sciences. PMID: 12114274.
- Liu Y, Kam WR, Sullivan DA. (2021). Androgen and Meibomian Gland Dysfunction: From Basic Molecular Biology to Clinical Applications. PMC8165631.
- Jie Y, et al. (2016). Hormone Replacement Therapy Benefits Meibomian Gland Dysfunction in Perimenopausal Women. Medicine. PMC4979784.
- Fraunfelder FT, Sciubba JJ, Mathers WD. (2012). The Role of Medications in Causing Dry Eye. Journal of Ophthalmology. PMC3459228.
- Guo M, et al. (2024). Association Between Systemic Medication Use and Severity of Dry Eye Signs and Symptoms in the DREAM Study. The Ocular Surface. PMID: 38307463.
