therapeutic topics

Dry Eye Culprits of the Drug World

therapeutic topics
Dry Eye Culprits of the Drug World

One of the chief complaints that we encounter in contact lens practice is discomfort and dryness during lens wear. Many contact lens-related strategies can be considered to help combat these complaints which are often aimed at changing lens materials and lens replacement cycles, switching care systems, adding tear supplements, and improving lid hygiene. Although these changes may help the patient's complaints, the true root of the problem could be medications prescribed for acute and chronic systemic problems in your patient.

Drugs and Dry Eye

Pharmaceutical agents that contribute to dry eye complaints abound in many categories of commonly prescribed and over-the-counter medications. A change in contact lens comfort may be attributed to many other causes, while the role of medications may be overlooked. I will briefly discuss several pharmaceutical categories that contain drugs causing dry eye symptoms. Do not consider this list exhaustive as many other drugs and categories may have dry eye as side effects. In addition, although these categories of drugs are the traditional offenders in causing dry eye problems, exceptions within every category exist. Eyecare practitioners should further research specific drugs prior to condemning the entire drug category.

With the cold and flu season upon us, many of our patients will be self-medicating with OTC cold remedies and nasal decongestants. The components of anti-histamines and anti-cholinergics in these medications often lead to decreased aqueous production with the subsequent complaint of dryness with or without contact lens wear.

Anti-hypertensive medications that are B-adrenergic blocking agents also cause complaints of dry eye. These B-blocking agents are also used in the treatment of cardiac arrythmias, ischemic heart disease and migraine headaches.


TABLE 1 Drug Categories That May Cause Dry Eye


  • Decongestants

  • Anti-acne

  • H1 Anti-histamines

  • Anti-anxiety agents

  • B-Adrenergic blocking agents

  • Anti-cholinergics

  • Oral contraceptives

  • Tricyclic anti-depressants

Although oral contraceptives have been implicated in producing dry eye-related complaints, the supportive research in this area has not been as conclusive. Vague side effects of contact lens intolerance are often noted in the literature with subsequent dry eye-related side effects.

Isoretinoin is used to treat patients with cystic acne and affects the over-production of skin lipids. This drug may also impact the production of the lipid layer of the tears, making them more susceptible to instability. This alteration of tear film stability can lead to dry eye symptoms and decreased contact lens tolerance.

Widely prescribed anti-anxiety medications and tricyclic anti-depressants can also produce dry eye side effects. With these medications being prescribed to a broader and younger population, the likelihood of your contact lens patients crossing paths with these side effects is increased.

Ultimately, the issue is successfully co-existing with prescribed and OTC medications that may compromise contact lens success. The best course of action is producing solid patient education about the role of the medications in their complaints. At the very least, you should make every patient aware of the part that his medications may be playing in the decreased comfort of his contact lenses.

Dr. Schornack is the Assistant Dean of Clinical Education and serves in the Cornea and Contact Lens Service at the Southern California College of Optometry.