Dry eye therapy is designed to provide some relief from the symptoms of several types of dry eye. But not all dry eye is the same. Dry eye is more a collection of symptoms than the single result of one thing.
It generally falls into two groups: evaporative dry eye and aqueous-deficient dry eye. Sometimes there is some kind of stress on the centers controlling your tear production. But did you know medication can sometimes involve active ingredients that dry your eyes out as well? We’ve found 12 medications that can make trouble for your eyes’ tear composition.
Evaporative Dry Eye
With evaporative dry eye, there’s something wrong with the oil layer of your eyes’ tear film — so your natural level of tears evaporates too quickly. The meibomian glands produce the oil layer and secrete through openings in your eyelids.
Aqueous-Deficient Dry Eye
With aqueous-deficient dry eye, there’s something wrong with the water layer of your tear film. The water isn’t evaporating, so much as there’s a lot of tears missing. The lacrimal glands produce the tears that keep your eyes moist and flow steadily through your tear ducts.
How Medication Works
Medications some take to relieve a disease or condition often come with unintended side effects. When the active chemical agents work on our body’s chemistry, sometimes glands and organs having nothing to do with the problem area affected. The meibomian and lacrimal glands are no exception. It’s best to know some of the medication categories that can disrupt your tear film’s natural oil and water levels.
These mood stabilizers sometimes have an adverse effect while they’re working, unintentionally blocking signals between nervous system receptors, which can lead to insufficient production of the water or oil layers. Adapin from Lotus Biochemical, Endep from Roche, Elavil from Merck, and Sinequan from Pfizer all work this way. Dry eye can result from deficiencies in water and oil.
Antidepressants falling under SSRIs work differently. Selective serotonin reuptake inhibitors (SSRIs) work within the brain between neurons, rather than on the central nervous system, so the active chemicals won’t reach the lacrimal or meibomian glands. Despite that, SSRIs can work in other ways and still produce side-effect dry eye. Zoloft from Pfizer and Paxil from GlaxoSmithKline are two well-known SSRI medications. Dry eye comes from a lack of water and oil.
Sleeping pills work in a similar way to Tricyclic antidepressants. They block signals between the nervous system and the body. Unfortunately, some of those signals include tear production at the lacrimal gland, so there’s aqueous deficient dry eye.
Medication for Parkinson’s Disease
Parkinson’s disease patients have involuntary movements that can be helped by inhibiting signals to the muscles. But again, the lacrimal gland can also be affected.
Antihistamines combat allergic reactions like rhinitis, urticaria, dermatitis, and other systemic allergies. But they can disrupt production in both the aqueous and the mucin (for mucous) layers. That means there isn’t enough moisture, and the water layer can’t latch onto the mucin layer for physical support.
Benadryl and Claritin are known for these side effects in some allergy sufferers. Newer, more targeted antihistamines, including Zyrtec, Clarinex, and Allegra, don’t have quite as many dry eye complaints, though.
Decongestants are designed to target mucous production, so the mucin layer struggles to provide the necessary foundation for the water layer, resulting in a thinner water layer. The mucin layer, produced in part by your eyelids’ and cornea’s goblet cells, acts as a scaffold for holding the tear film against the eye’s surface — so dry eye symptoms can be severe without the necessary adhesive support.
Hormones & Oral Contraceptives
For reasons not entirely understood, hormone replacement therapy (HRT) appears to interfere with adequate aqueous layer production. These medications are an artificial source of estrogen and progesterone. Oral contraceptives like birth control have a similar impact on the lacrimal glands. What’s more, there are about 29% more eye symptoms when taking estrogen and progesterone at the same time, compared to estrogen by itself.
Hypertension medication refers to pills you can take for high blood pressure. They use beta-blockers in the bloodstream for so you can lose some blood pressure. But beta-blockers free-floating in your system sometimes end up in your lacrimal gland, resulting in dry eye symptoms. There’s also the issue of beta-blockers having a record of inducing a loss of feeling in the cornea. Overall, eye irritation can also be the result.
Some treatments for several kinds of acne and psoriasis rely on Vitamin A and its derivatives. Isotretinoin (13-cis-retinoic acid) is one kind of vitamin A where excess particles affect your eye, especially the lacrimal gland. This side-effect sabotages the meibomian gland.
Even though water production works, oil production runs lower, leading to dry eye symptoms. Your tear film doesn’t bounce back quickly from the meibomian gland disruption, even months after you’re no longer taking it.
Pain relievers like to Darvocet-N, ibuprofen, and Lortab all involve unintended dry eye symptoms. Ibuprofen can produce more side effects on top of that, like blurry vision, prescription changes, diplopia, and color perception.
Many gastrointestinal medications produce a dry eye side effect, including Prilosec from Procter & Gamble, Prevacid from Takeda, Nexium from AstraZeneca, and Zantac and Tagamet, both from GlaxoSmithKline.
These medications can all include active H2 receptor inhibitors or proton pump inhibitors (PPIs) ingredients, each decreasing stomach acid production. But these agents can often come with dry eye side effects.
Chemo medication can come in many forms with many unintended results. But one chemo drug has a dry eye side effect in as many as 60% of patients. Sjogren syndrome is an autoimmune disorder where dry eye symptoms stem from the immune system attacking lacrimal and salivary glands. A drug called Cytoxan from Bristol-Myers Squibb is used to treat a couple of conditions, including primary Sjogren syndrome — and it can cause dry eye symptoms on top of the autoimmune attack on the lacrimal gland. Aqueous deficient dry eye is likely to result.
Thorazine from GlaxoSmithKline has been replaced by Phenothiazines, including Mellaril from Mutual Pharmaceutical, each medication for schizophrenia. But both kinds decrease the tear production, which leads to aqueous-deficient dry eye.
Dry Eye Therapy
But there are more medications or combinations of medications that come with dry eye side effects. However, these are the categories that contain most of the individual ones. While dry eye side effects are uncomfortable, it’s essential to take your medication as expressly directed by your physician. That means you shouldn’t stop, despite dry eye.
Dry eye therapy comes with many treatment methods. If you get help from your eye doctor on which ones will balance your tear film with your current medication — there might be a way forward with dry eye relief. Book an appointment to find out how!