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If your eyes started to feel dry at around the same time you started a new medicine, it may not be a coincidence. Many medicines, as tablets and as drops, can affect the tears. This page helps you recognise the link and understand what to do, without harming the treatment you need.
The most important rule: never stop or change a medicine because of dry eyes without first talking to the doctor who prescribed it. In most cases the dryness can be treated and the essential treatment continued.
How medicines cause dryness
Tears are made up of three layers: a mucous layer that clings to the eye, a watery layer from the tear gland, and an oily layer from the meibomian glands (small glands in the eyelid margins). Medicines can affect each of them. Some medicines reduce tear production through the nervous system, some damage the meibomian glands, and some drops irritate the surface of the eye directly.
The effect differs from person to person. It is more noticeable when several medicines are taken together, at an older age, and in people who are already prone to dryness.
Tablets that can cause dryness
The following list includes groups of medicines that have been linked to dry eyes. It is not complete, and not everyone who takes these medicines will have dryness:
- Antihistamines (allergy medicines), especially the older type that causes drowsiness, and nasal decongestants.
- Antidepressants and anti-anxiety medicines, including medicines from various groups, and antipsychotic medicines.
- Anticholinergic medicines (medicines that block certain nerve signals), such as some medicines for an overactive bladder.
- Some blood pressure medicines, such as beta-blockers and diuretics.
- Isotretinoin (a medicine for severe acne), which damages the meibomian glands. In some people the effect continues even after the treatment ends.
- Certain hormonal treatments, such as treatments that suppress sex hormones.
- Some oncological treatments (treatments for cancer).
If you take one of these medicines, it still does not mean that it is the cause of the dryness. Dry eye has many causes, and the examination helps you understand what is really going on.
Eye drops that can cause dryness
Sometimes, surprisingly, the very drops intended to help irritate the eye:
- Drops with preservatives, especially benzalkonium chloride (BAK). With long-term or frequent use it can damage the surface of the eye. This is particularly important for people who have used glaucoma drops (for high pressure inside the eye) for years. A full explanation is on the preservative-free eye drops page.
- Anti-redness drops (which constrict blood vessels), which with regular use can cause rebound redness and irritation.
- A combination of many different drops a day, which increases exposure to preservatives.
What about over-the-counter medicines and supplements?
Medicines bought without a prescription can also affect the tears, for example allergy tablets or cold remedies that contain a decongestant. Many people do not think of these as "medicines" and so do not mention them to the doctor. Various dietary supplements are also sometimes taken regularly, and it is worth mentioning them. When you prepare a list of medicines for the visit, include everything, even what you take only occasionally.
How to tell whether a medicine is linked to dryness
There are several clues: the dryness started or got worse in the weeks after starting a medicine or increasing its dose; there is also a dry mouth; or the dryness gets worse every time certain drops are used. It is worth writing down when the symptoms started and what changed at that time.
Bring to the examination a complete list of all your medicines, including over-the-counter medicines, dietary supplements and drops. The list helps the doctor see the full picture.
What the eye doctor checks
The eye doctor checks which part of the tears is affected: whether there is a lack of tears, whether the meibomian glands are blocked, and whether there are signs of toxicity from drops on the surface of the eye. The examination includes a symptom questionnaire, a slit-lamp examination, staining with fluorescein (a harmless yellow-orange dye), measurement of tear break-up time, a Schirmer test and examination of the meibomian glands. Details are on the dry eye testing page.
At the end of the examination you will receive a written summary of the findings and recommendations. You can share it with the doctor who prescribed the medicine, to help them consider whether a change in treatment is appropriate.
Treatment options
First of all: a conversation with the doctor who prescribed the medicine
Sometimes it is possible to change the time the medicine is taken, adjust the dose, or switch to another medicine from the same group. Sometimes the medicine is essential and has no alternative, and then it is continued and the dryness is treated. This decision belongs to the doctor who prescribed the medicine, together with you. The pharmacist can also help identify medicines linked to dryness.
To make the conversation effective, you can ask the doctor who prescribed the medicine:
- Are dry eyes a known side effect of this medicine?
- Can the time of day or the dose be changed without affecting the treatment?
- Is there an alternative from the same group that affects the tears less?
- If I need to continue the medicine as it is, is there anything I should know before treating the dryness?
The answers depend on your medical condition, and sometimes the right answer is to carry on exactly as you are and treat the dryness separately. That is fine: today there are many ways to ease dryness even when the medicine stays.
Treating the dryness
Preservative-free lubricating drops, warming and cleaning of the eyelids when the meibomian glands are involved, and reducing environmental factors such as direct air conditioning and long hours at screens. People who use glaucoma drops can ask their treating eye doctor whether a preservative-free alternative exists. The eye doctor may also prescribe anti-inflammatory drops when there is inflammation of the eye surface.
Treatments at the clinic
- Meibomian gland expression and IPL treatment, when the glands are blocked. It is important to know that some medicines increase sensitivity to light and affect suitability for IPL, so your list of medicines is checked before treatment.
- Punctal plugs, when there is a lack of tears, so that the tears stay on the eye for longer.
Working together with your treating doctors
Dryness caused by a medicine is a good example of the need for coordination. The family doctor, psychiatrist, cardiologist, dermatologist or oncologist is responsible for the main treatment, and the eye doctor is responsible for the surface of the eye. When each knows what the other has found and prescribed, it is easier to find a balance that protects both your general health and your eyes.
When to see a doctor straight away: severe eye pain, reduced vision, marked sensitivity to light, a very red eye or a white spot on the cornea. If a widespread rash, blisters on the skin or in the mouth, and red, painful eyes appear after starting a new medicine, go to the emergency department immediately: this may be a severe reaction to the medicine.
In summary
Medicines are a common cause of dry eyes, and the dryness can often be treated without giving up essential treatment. Do not stop a medicine yourself; talk to the doctor who prescribed it, and get examined by an eye doctor. If ordinary drops are not enough, a dry eye specialist can check exactly what is affected and offer tailored treatment.
Want a basic explanation first?For basic information on artificial tears: the guide on the Mitzmutz site
Frequently asked questions
I think a medicine is drying my eyes. Should I stop it?
No. Do not stop or change a medicine yourself. Contact the doctor who prescribed it: sometimes the dose or timing can be adjusted, and sometimes the medicine is continued and the dryness is treated.
How long does dryness from a medicine take to go away?
It depends on the medicine. Sometimes the dryness improves after a change made on the doctor's instructions, and sometimes, for example after isotretinoin treatment, the change in the meibomian glands lasts longer.
I use glaucoma drops and my eyes are dry. What can be done?
Preservatives in drops, especially with long-term use, can irritate the surface of the eye. Tell the eye doctor who treats your glaucoma; preservative-free alternatives are sometimes available. Do not stop the drops yourself.
Do anti-redness drops dry the eye?
Drops that constrict blood vessels hide redness for a short time, and with regular use they can cause rebound redness and irritation. If you need them every day, it is worth getting examined to find out the cause of the redness.
Home care not enough? We can look into it.
At the dry eye clinic in Haifa we find out what is causing the dryness and build a personal treatment plan.
Sources
- Wong J, Lan W, Ong LM, Tong L. Non-hormonal systemic medications and dry eye. Ocul Surf. 2011;9(4):212-226.
- Gomes JAP, Azar DT, Baudouin C, et al. TFOS DEWS II iatrogenic report. Ocul Surf. 2017;15(3):511-538.
- Baudouin C, Labbé A, Liang H, Pauly A, Brignole-Baudouin F. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010;29(4):312-334.
- Akpek EK, Amescua G, Farid M, et al. Dry Eye Syndrome Preferred Practice Pattern®. Ophthalmology. 2019;126(1):P286-P334.
The information on this site is general only. It is not medical advice and does not replace an examination by an eye doctor.