7 Medications That Can Cause Dry Eyes

A surprising number of over-the-counter and prescription meds can cause dry eyes.

Insufficient tear production can lead to sensations of dryness, grittiness, burning, or stinging in the eyes, among other discomforts. Dry eye syndrome, a chronic condition surpassing transient dry eye episodes, can arise from various factors, including potential medication-induced effects. This prompts consideration: could the medications one consumes be contributing to the issue?

Often, individuals utilizing both over-the-counter and prescription drugs remain unaware of the substantial impact that common pills, sprays, drops, and liquids may have on depriving the eyes of necessary moisture. An array of medications, ranging from cold remedies to prescription heart medications and allergy treatments, can trigger dry eye symptoms.

For individuals undergoing multiple medication regimens, the risk to ocular health becomes even more pronounced. Stephanie Crist, Pharm.D., an assistant professor of pharmacy practice at St. Louis College of Pharmacy in Missouri, emphasizes that the cumulative effect of multiple medications can intensify the potential threat to the eyes.

In the event that any of your medications appear to be contributing to eye dryness, it is advisable to engage in a dialogue with your healthcare provider. This conversation can pave the way for discovering strategies to alleviate discomfort and preserve ocular health.

Antihistamines and Dry Eyes

Substances like Flonase (fluticasone), Allegra (fexofenadine), Claritin (loratadine), Zyrtec (Cetirizine), and Benadryl (diphenhydramine) belong to the category of antihistamines. These compounds function by obstructing the action of histamine, a chemical that the body releases in its response to allergens.

Antihistamines play a crucial role in alleviating symptoms stemming from allergies and colds, effectively addressing issues like sneezing, itching, watery eyes, and a runny nose. Nonetheless, their impact extends to the eyes, where they can influence the natural tear film responsible for maintaining ocular moisture.

A noteworthy aspect of this situation is the similarity in symptoms between dry eyes and allergies, which can lead to confusion. As highlighted by Steven Maskin, MD, the medical director of the Dry Eye and Cornea Treatment Center in Tampa, Florida, the sensation of scratchiness and grittiness due to a lack of watery tears might prompt introspection. Individuals experiencing these sensations could consider whether recent consumption of a medication like Benadryl or other allergy-related medications triggered their dry eye symptoms, particularly if they had initially taken these medications in response to sneezing or other allergy indications.

Nasal Decongestants

The comfort provided to a congested nose might not extend the same gentleness to the eyes. Over-the-counter decongestants serve as the remedy of choice for alleviating symptoms related to colds, the flu, hay fever, and sinusitis. These medications function by constricting the blood vessels within the nasal membranes, effectively reducing the blood flow to swollen nasal tissues. This mechanism facilitates improved airflow through congested nasal passages.

Available in various forms such as pills, liquids, and nasal sprays, nasal decongestants are marketed under diverse brand names, containing active ingredients like phenylephrine, pseudoephedrine, and oxymetazoline. However, akin to antihistamines, decongestants share the propensity to diminish tear production. Some products found on pharmacy shelves even combine the effects of an antihistamine and a decongestant, thereby posing a dual challenge to ocular health.

Blood Pressure Lowering Drugs

Individuals undergoing prescription treatments to manage blood pressure and address specific cardiac conditions might also encounter the issue of dry eyes. For instance, medications known as beta-blockers are employed to decelerate heart rate, diminish the vigor of heart muscle contractions and relax blood vessel constriction. Nonetheless, these medications are believed to reduce the sensitivity of the cornea, the translucent front surface of the eye. This alteration can subsequently diminish the trigger that prompts tear glands to release the necessary moisture. Dr. Maskin further elucidated this phenomenon.

Another category of blood pressure-regulating drugs, diuretics, commonly referred to as water pills, also play a role in the occurrence of dry eyes. Drugs like Microzide (hydrochlorothiazide) and Lasix (furosemide) encourage increased urine excretion by the body, effectively facilitating the removal of excess water from both the body and the eyes.

Antidepressant, Antipsychotic, and Parkinson’s Medications

Elavil (amitriptyline), categorized as a tricyclic antidepressant, and thioridazine, commonly prescribed for managing schizophrenia, are part of a class of medications exhibiting anticholinergic effects. These substances impede the transmission of specific nerve signals and consequently give rise to particular side effects, including the occurrence of dry eyes.

Similarly, Artane (trihexyphenidyl), utilized to counteract stiffness, tremors, and spasms characteristic of Parkinson’s disease, also possesses anticholinergic properties. Dr. Maskin clarifies that under typical circumstances, a healthy nerve detects the presence of eye dryness and initiates a signal relay that progresses until it reaches its intended destination, triggering the release of tears. However, when this communication network experiences disruption, the message remains undelivered, ultimately culminating in the development of dry eye symptoms.

Even prominent medications such as Zoloft (sertraline) and Paxil (paroxetine), belonging to a distinct category of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), can contribute to the onset of dry eye discomfort.

Hormone Therapy and Oral Contraceptives

Hormone therapy introduces a complex interplay with dry eye symptoms. Individuals undergoing hormone therapy for managing menopausal effects, particularly in cases of using estrogen as a standalone treatment, face an elevated risk of experiencing dry eyes. Among post-menopausal individuals, those who exclusively utilized estrogen replacement therapy witnessed a 70% heightened susceptibility to dry eye disease. Meanwhile, those opting for a combination of estrogen and progesterone encountered a 30% increased risk of developing dry eyes.

Similarly, hormonal shifts attributed to the use of birth control pills can also contribute to the onset of dry eye symptoms. The employment of birth control pills correlates with a heightened SANDE score—an indicator of dry eye symptoms, with elevated scores indicating a greater likelihood of experiencing dry eyes.

Dr. Maskin elaborates on the intricate connection between hormones and ocular dryness, acknowledging that the precise relationship remains unclear. He suggests that estrogen might exert adverse effects on the oil-producing glands within the eye. Furthermore, estrogen could potentially impact the aqueous, or water-based, layer of the tear film, thereby contributing to dry eye discomfort.

Acne Medicine and Dry Eyes

Dermatologists occasionally prescribe isotretinoin for the management of severe, scarring acne or cases where acne remains unresponsive to alternative treatments. Initially marketed as Accutane, this potent medication significantly influences oil glands by inducing a drying effect. Among its array of common side effects, irritation of the eyes and eyelids is notably prevalent.

Dr. Crist explicates that isotretinoin contributes to an overall reduction in mucus production and secretion, a factor associated with its effects on ocular comfort.

Accutane’s history is marked by a range of concerns, encompassing associations with birth defects, depressive symptoms, suicidal ideation, and gastrointestinal disorders. While its manufacturer, Roche Pharmaceuticals, withdrew it from the market in 2009, generic versions of the medication still remain accessible.

Eyedrops

It might be counterintuitive, but certain types of eye drops can actually worsen the discomfort of dry eye symptoms.

Dr. Maskin emphasizes the need to steer clear of the eye drops commonly referred to as “redness relievers.” For instance, Visine (tetrahydrozoline ophthalmic) functions by constricting blood vessels within the eyes to diminish redness. However, once the effects of these drops wear off, the blood vessels tend to dilate again, potentially leading to renewed inflammation.

Dr. Maskin underscores the importance of addressing the underlying cause of redness rather than merely attempting to conceal it. The focus should be on identifying and managing the root cause of the issue rather than relying on temporary solutions that might exacerbate the problem.

A Quick Review

When seeking relief for cold, flu, or allergy symptoms, individuals often resort to readily available over-the-counter products. Yet, a commonly overlooked and bothersome side effect accompanies these choices: dry eyes. Effective eye lubrication is vital for optimal eye function, but certain medications utilized to manage symptoms or specific health conditions can inadvertently contribute to ocular dryness.

For individuals employing antihistamines, nasal decongestants, blood pressure-lowering medications, antidepressants, antipsychotics, Parkinson’s disease treatments, hormone therapy, oral contraceptives, acne medications, and even eye drops, the potential for experiencing chronic dryness and irritation in the eyes becomes a noteworthy concern.

Should the scenario of chronic dry and irritated eyes unfold, seeking the guidance of a medical professional is prudent. Their expertise can facilitate accurate diagnosis and tailored treatment to alleviate these symptoms and safeguard ocular comfort.