19 Medications That Cause Dry Eyes | Rethinking Dry Eye Treatment

In this modern world, sometimes it seems just about everyone is taking some kind of prescription drug – sometimes several —and the older the person, the more likely they will be taking more than one prescription medication. Many of these drugs have side-effects. They don’t always hit everyone, but if you are regularly taking more than one, the side effects can begin to add up. One common side effect to be aware of is dry eye!

Have you noticed your eyes becoming dry, feeling like there are scratches on them, or just that you need to blink several times to get a little moisture going? The root cause may lie in your medicine cabinet. Here are several common drugs that can cause dry eye symptoms:

Antidepressants (Paxil, Prozac, and Others)

Antidepressants change chemicals in your brain, which means messages traveling through your nervous system get rerouted and reinterpreted. Any drug that operates in that manner, including ones used for the treatment of mental health issues, can have a negative impact on vision, disrupting the messages received by the cornea (the front of the eye) and optic nerve (the back of the eye). As an example, Prozac is reported to have side effects including eye pain, double vision, dry eye, and inflammation of the eyelids. If you’re taking a medication such as this, discuss your options with your doctor. Although many definitely need these medications, some people may benefit greatly from meditation and other stress and anxiety reducing techniques. Click here to read our 7 Relaxation Techniques for Stress Management and Anxiety Relief.

Antihistamines and Decongestants (Zyrtec, Claritin, Benadryl)

Antihistamines, as the name implies, are medications that block histamine receptors.  Decongestants especially target the eyes and nasal areas because the symptoms they treat are itchiness and runniness of the eyes and nose, and they do this by drying out those areas. Antihistamine eye drops for eye care are not any better. 

If you suffer from allergies and dry eye problems, consider checking with your doctor for something other than over-the-counter drugs. Allegra can often help with both problems because it is site-specific in its effects. If possible, taking an allergy formula without the decongestant can also help greatly. In addition to this, when it’s not allergy season for you, discontinue these medications all together.

Beta Blockers (Metoprolol, Propranolol) and Other Hypertensive Medications 

These are generally prescribed for those with chronic high blood pressure, heart attacks, and migraines, and one of their primary side effects is dry, itchy, and painful eyes. Watch out for this!  Beta blockers (which end in -ol) cause dry eye by reducing aqueous production from your lacrimal gland. Some others to be aware of are hydrochlorothiazide (HCTZ) and other diuretics. 

You can do something about this.  Talk to your physician about switching to another high blood pressure medication that does not cause dry eyes to such an extent.  I am in no way saying that you should go off your blood pressure medication, because you're probably on that for a very good reason and a heart attack is a lot more deadly than dry eyes. Just make sure you talk to them about alternatives. Speaking of alternatives to medication, a healthy diet, exercise and hydration can really make quite an impact on blood pressure as well! Click here to read more about the benefits of a healthy diet and check out this article all about exercise.

Oral Antibiotics 

You wouldn’t think this would be an issue, but most of these can cause dry eyes. Amoxicillin and Penicillin can also both cause itching, dryness, and redness of the eyes. For some, they even cause problems with balance – so while taking oral antibiotics, consider adding in some Vitamin C and acidophilus probiotics to counteract some of the worst side effects. Antibiotics can also wreak havoc on the gut, destroying even the healthy bacteria our gut needs to thrive. Probiotics can help with this, although it’s best to avoid antibiotics whenever possible. Unless you have a life or sight threatening condition that requires them, just say no!

With that being said, many eye doctors use Doxycycline and other tetracycline antibiotics for the actual treatment of rosacea and meibomian gland dysfunction. While this antibiotic will destroy your gut flora, just like all of the other ones, Doxycycline actually has an anti-inflammatory component that can be very helpful for those dealing with certain types of dry eye. Taken in small, short doses, this can be a great addition to an MGD routine.   However, we recommend avoiding this where possible and following the changes recommended in our book, Rethinking Dry Eye Treatment.

OTC Pain Relievers (Ibuprofen, Tylenol)

If you are on a regular regime of over-the-counter pain meds such as ibuprofen or acetaminophen, you may also experience dry eye symptoms. If so, try lowering the dosage slightly and drink more water to help solve the problem instead. Prescription pain relievers are no different and can even be worse for dry eyes. You’re better off finding other ways to cope, if possible. Homeopathic remedies, such as arnica montana, can be great to have in your pain relieving arsenal. 

Hormones and Birth Control

Anything that messes with the hormones in the body is going to cause dryness issues. This is often the reason why many women in menopause experience dryness.  A few examples of potentially problematic medications include Hormone Replacement Therapy (HRT) predominantly with estrogen, or even progestin. This is pretty commonplace in a lot of women that are postmenopausal. So, you might be in this group. There are additional ways that you can combat the negative effects of HRT, and these include hydration and eating a well balanced, vegetable rich diet.  If you’re taking HRT or struggling through menopause, we recommend reading Dr. Anna Cabeca’s book The Hormone Fix for tips on how to naturally prevent the symptoms of menopause. 

In addition to this, birth control can be problematic for those with dry eyes as well. If you can go without, we recommend it. There are other ways to prevent conception, including natural family planning, that are very effective for many people. Click here to read more in the book, Taking Charge of Your Fertility.

Gastrointestinal Medications: Prevacid, Prilosec, Nexium, Zantac, and Tagamet

These medications are proton pump inhibitors and help with GERD (acid reflux).  Acid reflux, gas, and other digestive issues can usually be resolved by figuring out what foods or drinks are causing the issue, and eliminating those. In fact, some of these medications can be incredibly dangerous for you in the first place, so eliminating them completely is your best option. As an alternative, try apple cider vinegar to help decrease any acid reflux you’re experiencing. Click here to read more about the benefits of Apple Cider Vinegar.

Chemotherapy

Up to 60% of Chemotherapy patients develop dry eyes. The most well known medication to be of issue is Cytoxan. This is also, interestingly enough, used to treat some ocular conditions, such as Sjogren's syndrome, but as many as 60% of patients that take this medication develop dry eye. When going through chemotherapy, there is not much you can do except combat the side effects as best you can.

This can be done by usingpreservative-free artificial tears like Oasisas needed and ensuring that your diet and hydration are top notch during this time is crucial, and doing your best to stay on top of your dry eye routine will surely help you get through the dry eye symptoms.

Antipsychotic Medications 

These are often used to manage schizophrenia and bipolar disorder. However, antipsychotic medications can cause dry eye as well. They usually decrease your aqueous secretion and symptoms are usually dose dependent. So, if you take a higher dose, of course you're more likely to have dry eye. If you find that the dry eye is causing detriment to your life, discuss other options with your doctor. However, it may be that you’ll need to simply do the best you can to treat the dry eye symptoms stemming from these medications, such as using artificial tears eye drops for the surface of your eye, enhancing tear production with omega-3 fatty acids, and treating your meibomian glands (oily tear glands) with eyelid hygiene.

Accutane and Other Retinoids 

This is the biggest no-no of the list. Accutane is taken for severe acne, often in teenagers and adults, but it can have dire side effects.  It actually can kill off your meibomian glands and cause them to atrophy, leaving you with no lipid layer of tears, disrupting your tear film, and leading to severe evaporation and very dry eyes.

Accutane is just a form of vitamin A in really high doses, which is definitely not good for your eyes. It’s a well known cause of dry eyes and atrophy of your glands because, just like it shrinks the oil producing glands of your skin, it does the same to your eyes.  Avoid this at all costs and look for other ways to help calm your acne, such as using the Heyedrate Tea Tree Oil Soap.

Since we’re on the topic of retinoids, you need to be avoiding them completely. This includes night creams and other anti-aging moisturizers and serums containing retinol in any form. We recommend trying a natural option such as theHeyedrate Eye Cream and Face Moisturizer.

Accutane is a brand name for isotretinoin, a vitamin A derivative used to treat severe cystic acne in those who have failed with other treatments. It is a retinoid and works by decreasing facial oil secretion, thereby drying up and preventing acne breakouts. This medication has been used for years to treat severe acne, often in teenagers, and the side effects can be devastating both at the time and later in life. 

NOTE: Accutane is no longer on the market in the US. However, the manufacturer does have it available in other countries, and the US has multiple generic and brand name options available.

History of Accutane for Acne

The FDA approved Accutane in 1982 for the treatment of severe acne unresponsive to conventional therapies (this may include topical creams and gels, and oral antibiotics). It was given a pregnancy X category rating, meaning it is completely contraindicated during pregnancy due to devastating birth defects. Two years later, the FDA mandated the company give this medication a black box warning due to the risk of fetal deformity.

In the years after, a pregnancy prevention program was put into place in an attempt to ensure that patients were not taking the medication while pregnant. Psychiatric events and suicidal tendencies were also a big deal during this time, and something that the manufacturer and the FDA worked to become more aware of and decrease. 

The first generic version of the medication was introduced after Accutane’s patent ran out in 2002, and soon after (in 2005) the iPLEDGE program began. With this program, all patients with a prescription for any version of isotretinoin had to show a negative pregnancy test each month before being able to refill their prescription. Blood work is also required regularly while on this medication due to the potential for organ toxicity.

The history of this medication is incredibly rocky, as you can see. However, so many people have been prescribed this medication and have taken it for the treatment of severe acne.

Accutane Ingredients

Accutane contains isotretinoin, a retinoid and vitamin A derivative. The dosage is dependent on the condition itself and the weight of the individual. Other brand names for this medication include Absorica, Amnesteem, Claravis, Myorisan, Sotret, and Zenatane.

So, is isotretinoin (or any of the branded versions) safe to take? This is all relative, of course. Someone with severe acne that is devastating for their self esteem may say that this medication is absolutely worth any side effect that occurs. However, we know of countless patients who have suffered in the wake of taking this medication years ago, and now have to deal with other conditions that have become impossible to control.

We’re talking mostly of dry eye disease, which we’ll get into a bit deeper, but there are other side effects to be aware of as well.

Accutane and Dry Eyes

Because isotretinoin effectively works by shrinking the sebaceous glands of the skin, this medication can lead to severe, and sometimes irreversible, dry eye disease. The meibomian glands of the eyelids are sebaceous glands that normally produce healthy oils for the tear film. When these can no longer function, the tears evaporate quickly and the eyes become very dry.

This is a known side effect of Accutane. The medication is secreted into the tears by the lacrimal gland, and is known to induce atrophy of the meibomian glands, which then leads to not only changes in lipid secretion but also increases in tear osmolarity that affect tear film stability. Simply put, this medication can cause issues with both the lacrimal gland system (responsible for the watery portion of your tears) and the meibomian glands (which produce the oil for your tears. It’s a double whammy. In some people, this is not an issue and the damage is mild, however there are many people in which the damage done is permanent and severe.

The only way to know if you still have functioning meibomian glands is to have them imaged by your eye doctor. After that, they can give you a plan of attack for treating Accutane induced dry eye disease, and we’ll cover a few options below. 

Accutane and Birth Defects

As early as 1982, and possibly earlier, it was known that isotretinoin had the ability to cause birth defects. Many measures were put in place to decrease the chances of someone becoming pregnant while on this medication, and I remember having to go through the process when I considered taking the medication for my cystic acne in high school. I am ever thankful that I decided the side effects were too much of a risk for me, but I know many people are not as lucky. 

In order to obtain this medication from the pharmacy, you must present two negative pregnancy tests  before your first dose as well as provide a negative pregnancy test before each subsequent monthly refill. Waivers must be signed that you will use two forms of birth control at all times. Breastfeeding while on this medication is also not recommended, as similar medications  are known to pass into breast milk and the effects are unknown. 

Accutane and Hair Loss

Because isotretinoin affects the sebaceous oil glands of the skin, including the scalp, thinning hair is a very common side effect of this medication. While the drug inserts will state that this is temporary and your hair is likely to grow back after you stop the medication, this is not always the case. Accutane can actually damage the hair follicles, leading to permanent hair loss.

Accutane and Depression

Mental changes due to this medication are common, and many instances of depression, anxiety, and suicidal tendencies have been reported since the medication was introduced in the 1980s. By 2002, there were over 6000 reports to the FDA Adverse Event Reporting System for psychiatric events such as depression and suicidal thoughts. Many of these reports were reports of suicide while using the medication. Since that time, the FDA has worked alongside doctors and pharmacists to decrease the chances of this occurring, screening patients and actively reporting issues such as this.

Accutane and Dry Lips

Dry lips and mouth are incredibly common isotretinoin side effects. It has been recommended by many doctors to use Vaseline, ice chips, sugarless hard candy or gum, and saliva substitutes to decrease the effects of the medication while using it. However, it’s likely better to prevent the issue in the first place! Accutane affects the oil glands and while it can affect the skin anywhere on the body, it often has a greater effect on the lips because of their very high cellular turnover rate. The same can be said for the eyes as well!

Accutane Headaches

Headaches are possible on isotretinoin, and if they are persistent it’s important to talk with your doctor about discontinuation right away. Although rare, Accutane is a cause of pseudotumor cerebri (PTC) or idiopathic intracranial hypertension. This condition occurs when the pressure on the brain elevates, leading to a headache, blurred vision, and ringing in the ears. The eye doctor is often the first person to diagnose this condition, as the optic nerve can be seen to swell on evaluation. While it’s most common in obese patients and those of childbearing age, it can occur in anyone while on this medication. It is important to discontinue the medication before further damage to the optic nerve (vision) and brain are done.

Accutane Joint Pain

Another common side effect of Accutane use is joint and muscle pain, and this side effect may be permanent. This may be noted most when waking up in the morning with a stiff neck, and those who play contact sports may need to cut back while on this medication. It’s also known to stunt long bone growth in teens, so it should be used with caution in these individuals.

Treating dry eye disease after the use of this medication can present quite a challenge for the doctor, much to the frustration of the patient. Because Accutane has the potential to affect both the lacrimal and the meibomian glands responsible for producing normal, healthy tears, treatment must be multifaceted. 

First of all, ensure that your diet is top notch and full of plants! By decreasing inflammation overall in your body, you can help your glands produce healthy oil. Even if you only have a few meibomian glands left, this just increases the importance of a healthy diet. Get rid of the junk food, fried foods, food that comes in a box with a million ingredients, and added sugar. Check out this blog for more information on where to start (hint: it has to do with green smoothies).

In addition to an overall healthy diet, increase your intake of  triglyceride based omega-3 supplements. While it is often best to get omega-3s through food, it is sometimes not possible for everyone to eat wild caught (vs. farm raised) fish, and some people do not enjoy fish. For those people, we recommend omega-3 supplementation. Studies have shown that a ratio of 3:1 EPA:DHA is beneficial for dry eye disease.

 

Next, adopt an eyelid hygiene routine. You can find my exact routine here, but here are the basics:

Use an  oil based eye makeup remover to ensure you’re removing all eye makeup (a must for preventing bacteria build-up and further issues)

Wash your face with a  tea tree foaming face wash (tea tree essential oil is great for fighting inflammation of the face and eyelids)

Cleanse your eyelids and eyelashes with  hypochlorous acid. This is a natural substance made by your body, and it’s a must for keeping your eyelids clean.

Consider using the NuLids device for eyelid debridement and prevention of biofilm build-up.

There is  some research beginning to show that LipiFlow may have the potential to reverse meibomian gland atrophy, so this is promising. I know that the same type of research will soon be happening for Intense Pulsed Light (IPL) as well, and both may soon show benefits for those with meibomian gland atrophy.

With the discussion of dry eye disease often comes the discussion of eye drops, or artificial tears. For those with lipid layer deficiencies due to MGD, we often recommend preservative free lipid based tears. We usually recommend using them up to four times daily, although if they’re preservative free you can technically use them as needed. Here are a few of our favorite eye drops:

1. Oasis Tears Plus PF

We’re a big fan of these eye drops and the company that manufactures them. Available only through your eye doctor, Oasis Tears Plus PF is a great choice for anyone with dry eye disease. These drops work to lubricate, moisten and relieve delicate eye tissue from irritation and dryness. Oasis Tears is a true solution that keeps tears on the eye surface to relieve the irritation and gritty sensation that is commonly experienced with dry eyes.

Ingredients: Glycerin (0.22%), sodium chloride, sodium hyaluronate, sodium phosphate dibasic, sodium phosphate monobasic, water 

 

2. Retaine MGD 

This is another one we’ve used for years in our practices, and it’s a drop that works quite well for patients. Retaine MGD is a revolutionary preservative-free ophthalmic emulsion (meaning, you have to shake it before use) that moisturizes, lubricates and protects moderate to severe dry eyes. It is a milky white eye drop, so don’t be alarmed! It is a proprietary cationic oil emulsion technology that effectively delivers ingredients to the ocular surface.

Active Ingredients: Light Mineral Oil (0.5%) Mineral Oil (0.5%)

Inactive Ingredients: Cetalkonium chloride, glycerol, poloxamer 188, tris hydrochloride, tromethamine, tyloxapol, water for injection

3. Refresh Optive Advanced 

This artificial tear has been around awhile and is still a great option. It soothes dry eyes with an innovative triple-action formula that relieves common symptoms like burning, irritation, blurred vision, and grittiness. Refresh Optive Advanced Preservative-Free works on all three layers of the tear film to: 1. Lubricate; 2. Hydrate the surface cells of the eye; 3. Protect and help reduce tear evaporation. Shaking is not required.

Active Ingredients: Carboxymethylcellulose sodium 0.5%, Glycerin 1%, and Polysorbate 80 0.5%.

Inactive Ingredients: Boric acid; carbomer copolymer type A; castor oil; erythritol; levocarnitine; purified water; and sodium hydroxide

 

4. Refresh Optive Mega-3 

This is the only artificial tear made with a blend of natural oils, and it contains flaxseed and castor oils. These natural oils help fortify and restore the lipid layer of the tear film, which prevents tear evaporation when working properly. We like this new artificial tear because it helps nourish and protect all three layers of the tear film which can potentially be damaged by dry eye disease, and it contains omegas. This choice does not require shaking before use.

Ingredients:Carboxymethylcellulose sodium 0.5%, Glycerin 1%, Polysorbate 80 0.5%, boric acid; butylated hydroxyl toluene; castor oil; erythritol; flaxseed oil; levocarnitine; pemulen tr-2; polyoxyl 40 stearate; purified water; trehalose

 

5. Systane Balance

Systane Balance eye drops use clinical strength, intensive therapy to help relieve dry eyes. They really do work well to give you comfort that lasts. The only thing we don’t love about this choice is that it’s not preservative free, so we believe there are better options (above). However, this has been a mainstay lipid based artificial tear for years now. The restorative formula helps to restore the lipid layer of the tear film and replenishes essential moisture needed for it to function. If choosing this option, make sure you’re not using it more than four times per day due to the preservatives.

Active Ingredients:Propylene Glycol 0.6%

Inactive Ingredients: Boric Acid, Dimyristoyl Phosphatidylglycerol, Edetate Disodium, Hydroxypropyl Guar, Mineral Oil, Polyoxyl 40 Stearate, Polyquad® (Polyquaternium-1) 0.001 Preservative, Sorbitan Tristearate, Sorbitol and Purified Water.

Now that we’ve discussed the exact medications and medication families that can contribute to your dry eyes, let’s discuss exactly why this occurs. There are two main forms of dry eye disease. Aqueous Deficient Dry Eye simply means that the eyes are not producing the correct quantity of tears. More specifically, the lacrimal gland produces the watery, or aqueous, portion of your tears. When the lacrimal gland is either destroyed or affected in any way by medications or other conditions, it will not produce the tears needed to lubricate the eyes. As an example, antihistamines target this aqueous production and make it impossible for your lacrimal gland to produce the tears your eyes need to function comfortably.

Evaporative Dry Eye occurs when the tears on the surface of the eye evaporate away too quickly. Usually, this is due to having the incorrect quantity or quality of oil, or meibum, in your tears. The oily layer of your tears is produced by your meibomian glands in your eyelids. When these meibomian glands are blocked or destroyed, such as with the use of retinoids like Accutane, they will not produce oil. In addition to medications, what you eat and drink daily can even have an effect on the quality of oil your eyes produce!

If your eyes feel like they are constantly uncomfortable, then you likely are suffering from dry eyes. Persistent scratchiness, redness and burning are all common symptoms, as is the feeling that a foreign object is in your eye (called a foreign body sensation).

Dry eye symptoms appear to get worse in dry or windy climates and with higher temperatures and lower humidity (think Arizona weather). Symptoms may also be worse with prolonged focusing of the eyes (for example, while reading, watching TV, using a computer, and driving) and just before the end of the day, because you’ve strained your eyes all day long.

Occasionally, a symptom of dry eye syndrome may be excessive tearing. With dry eye, when the eyes become slightly dry and irritated, it may initiate reflex tearing from the lacrimal gland with the release of a great number of tears all at once to try to compensate for the irritation and dryness.

The eyes can only handle so many tears at once; the remaining tears end up pouring over the eyelids and sliding down the cheeks. Soon, the eyes will become slightly dry and irritated again, and the whole feedback process may repeat itself. 

Dry eye can be irritating at best and very painful at worst. It can show up with a range of signs and symptoms. Here are the ones to keep in mind:

Dryness

Itchiness

Scratchiness

Sensitivity to light

Discomfort when wearing contact lenses

Difficulty driving at night

Eye fatigue

Stinging

Burning

Redness

Pain

Watery eyes

Foreign body sensation

Stringy eye discharge that seems like mucus

 

While it seems that you may not be able to do much to help dry eyes, and there are often conditions which you cannot control (such as hormonal changes during pregnancy and menopause), you should be aware of other risk factors that you can control. This includes monitoring your life for all of the medications discussed above!

The two types of dry eye disease we talked about encompass all of the causes of dry eye out there, and medications are a huge factor in this. While it’s understandable that not everyone can discontinue their medications, it is possible to find other alternatives for many things and we’ve given some suggestions above. A simple discussion with your doctor can go a long way toward finding relief. Also, visiting a naturopathic doctor may also be of interest for those who wish to avoid pharmaceutical medications if possible.