The Patient's Guide to Dry Eye Syndrome: Medications Causing Dry Eye

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Dry Eye Syndrome is a nagging, disruptive condition that a large percentage of patients suffer from.  I know I have been dedicating a lot of posts to this topic, but there is still so much to cover!  For example, most of my patients are very aware of how their work environment or their contact lens routine contributes to their dry eye complaints, but medications that you are taking on a regular basis can have an equal, if not more pronounced, affect on dryness!  That's one of the many reasons that when you go to an eye doctor they inundate you with questions about your overall medical history.  I can look at a patient's medication list and quickly pick out offending meds that are making their dryness more unbearable.  Here are the most commonly used culprits:


1) DIURETICS    These are typically used to treat high blood pressure.  A diuretic causes your body to expel more fluid, so it is easy to see how this could lead to more severe dry eye.  
Examples: Furosemide, Hydrohlorothiazide, (HCTZ)



2) ANTI-HISTAMINES     Allergy season is quickly approaching, so a lot of Americans are going to start dosing the OTC and prescription strength oral allergy meds.  These medications can improve ocular symptoms like itching or puffy eyelids, but they are going to make your dryness a lot worse! 
Examples: Claritin, Zyrtec, Allegra

3) DECONGESTANTS     Cold medications constrict mucosal membranes (like your sinus tissue to prevent a runny nose).  Guess what, the eye is covered with a mucosal tissue to (called the conjunctiva), and constricting this tissue makes it really dry out.
Examples: anything with Pseudoephedrine

4) BIRTH CONTROL PILLS     We already discussed hormonal changes as a major contributor to dry eye in this post, so no surprise here.
Examples: Ortho-Tricycline, Yaz

5) ANTI-DEPRESSANTS     These medications can actually decrease production of the lacrimal gland, causing marked and sometimes devastating dryness.
Examples: Zoloft, Prozac, Lexapro, Wellbutrin


6) BETA BLOCKERS    These drugs inhibit the sympathetic nervous system, so they can prevent acute spikes in blood pressure.  But that also means they block sympathetic nervous system signals that cause lacrimation and salivation, resulting in dry eye and dry mouth.
Examples: Metoprolol, Atenolol

7) ACNE MEDICATIONS   Well not all of them, but the very commonly prescribed Accutane is a major offender.  Remember how we discussed in this post that the lipid component of the tear film is secreted by the meibomian glands?  Well meibomian glands are oily glands just like those on your face that cause pimples, so Accutane can cause the secretion in these glands to dry up and sometimes the glands even irreparably scar over.

This patient's meibomian glands are not even visible due to scarring from chronic dry eye.  Photo courtesy Optometric Mangagment


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