7 Medications That Can Cause Dry Eyes

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

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Inadequate tear production in your eyes can make them feel dry, burn, sting, or feel gritty, among other symptoms. Dry eye syndrome is a chronic condition that's more serious than just a one-time bout of dry eyes. There are different causes, and it can be a medication side effect.

If your eyes are dry and irritated, ask yourself: Could the little pill you pop each day be the culprit?

People taking over-the-counter and prescription medications may not realize the extent to which common pills, sprays, drops and liquids can starve the eyes of adequate hydration. Dry eyes can be caused by cold relief medicines, prescription heart medicines, allergy treatments, and more.

And for people on multiple drugs, the potential risk to the eyes is compounded, said Stephanie Crist, Pharm.D., assistant professor of pharmacy practice at St. Louis College of Pharmacy in Missouri.

If you are taking medications that are drying out your eyes—talk to your doctor to see how you can find relief for your eyes.

01 of 07

Antihistamines

Antihistamines such as Flonase (fluticasone), Allegra (fexofenadine), Claritin (loratadine), Zyrtec (Cetirizine), and Benadryl (diphenhydramine) block the effect of the chemical histamine, which the body produces in its attack against allergens, according to an article published in the American Academy of Opthalmology Practice Pattern, They can provide much-needed relief of allergy and cold symptoms, including sneezing, itching, watery eyes, and a runny nose.

Unfortunately, as the research article explained, these drugs also do a number on your eyes, reducing the watery tear film that keeps them moist.

The fact that dry eye can produce symptoms similar to an allergy can be confusing.

"If you have a scratchy, gravelly graininess, that's lack of watery tear," explained Steven Maskin, M.D., medical director of the Dry Eye and Cornea Treatment Center in Tampa, Fla. "Then ask yourself, did I just take a Benadryl the other day or an allergy medication because I started sneezing? That can dry you out," Dr. Maskin said.

02 of 07

Nasal Decongestants

What's soothing to a stuffy nose may not be so gentle on the eyes. Over-the-counter decongestants are the go-to medicines for easing cold and flu symptoms, hay fever, and sinusitis. As explained in a 2021 research article in Opthalmic Epidemiology, they work by narrowing blood vessels in the membranes of the nose. Blood flow to swollen nasal tissue is reduced, allowing blocked-up noses to breathe with greater ease. Nasal decongestants come as pills, liquids, and nasal sprays. They're sold under a slew of brand names containing ingredients like phenylephrine, pseudoephedrine and oxymetazoline.

But, as the research article explained, like antihistamines, they decrease tear production. Some products on the drugstore shelves combine an antihistamine and a decongestant—a double whammy on the eyes.

03 of 07

Blood Pressure Lowering Drugs

People who take prescription medications to lower their blood pressure and treat certain heart conditions, can also experience dry eye. Beta blockers, for example, slow heart rate, reduce the force of heart muscle contractions, and lessen blood vessel contraction. But these drugs are thought to decrease sensitivity of the cornea, the transparent window of the eye. When that happens, it can dampen the stimulus for tear glands to release tears, Dr. Maskin explained. Diuretics, also known as water pills, are another type of blood pressure-lowering medicine that work by encouraging the body to excrete more urine. Drugs like Microzide (hydrochlorothiazide) and Lasix (furosemide) flush excess water out of the body—and the eyes.

04 of 07

Antidepressant, Antipsychotic, and Parkinson's Medications

Elavil (amitriptyline), a tricyclic antidepressant, and thioridazine, which is prescribed for treating schizophrenia, are among a group of medicines that have anticholinergic effects. A 2022 review article published in Drugs and Aging explained that these drugs prevent the transmission of certain nerve impulses. Artane (trihexyphenidyl), used to combat stiffness, tremors and spasms in Parkinson's disease, has the same anticholinergic properties.

Normally, a healthy nerve would sense eye dryness and send a signal that gets passed along until it reaches its destination and tears are released. But when that communication network breaks down, the message becomes undeliverable. And that leads to dry eye, explained Dr. Maskin.

Popular medicines like Zoloft (sertraline) and Paxil (paroxetine) belong to a different class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). But they, too, can cause dry eye.

05 of 07

Hormone Therapy and Oral Contraceptives

Hormone therapy has a complicated effect on dry eyes. People who take hormone therapy to treat the effects of menopause, particularly estrogen alone, have a greater likelihood of developing dry eye. A 2016 research article published in Menopause described a research study that showed that post-menopausal people who used estrogen-only replacement therapy had a 70% increased risk of dry eye disease, and those who used a combination of estrogen and progesterone had a 30% increased risk of dry eyes,

You are also more likely to develop dry eye due to hormonal changes linked to the use of birth control pills. A 2019 review published in the Journal of Women's Health explained that individuals who use birth control pills had a higher SANDE score, which is a scoring system of dry eye symptoms: a high score corresponds to dry eyes.

The exact relationship between hormones and eye dryness is unclear, Dr. Maskin said. It could be that estrogen adversely affects the oil-producing glands of the eye. Estrogen may also reduce the so-called aqueous, or water, layer of the tear film, Dr. Maskin added.

06 of 07

Acne Medicine

Dermatologists sometimes prescribe isotretinoin for severe, scarring acne or acne that doesn't respond to other treatments. This powerful drug, once sold under the brand name Accutane, has a drying effect on oil glands. It's known to cause irritation of the eyes and eyelids, among other common side effects.

"It decreases overall mucus production and secretion," said Crist.

Accutane's checkered history includes a link to birth defects, depression, suicidal thoughts and bowel disorders. Although drugmaker Roche Pharmaceuticals pulled it from the market in 2009, generic versions are still available according to the Food and Drug Administration (FDA).

07 of 07

Eyedrops

It may sound surprising, but certain eyedrops actually exacerbate dry eye symptoms.

"Avoid the drops that 'get the red out,'" Dr. Maskin cautioned. Visine (tetrahydrozoline ophthalmic), for one, works by narrowing blood vessels to the eyes to reduce redness. But when the drops wear off, the vessels dilate and can become inflamed again.

"The key is to find out what's causing the redness, not to try to hide the redness," Dr. Maskin said.

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