Theoretically, any medication could cause an unusual reaction and worse perceived dry eye. Published papers showing a causal relationship of dry eye caused by a particular medicine is harder to come by.
The medication that dries out the eyes most commonly (because they are the most commonly used) are in this order, in my personal experience.
1. Any drop with a preservative.
2. Antihistamines pills
3. Any medicine with anti-cholinergic properties.
4. Anti-hypertensives
5. Anti-depressants
6. Accutane
But here are other lists as well.
A patient recently told me the Avodar he used for Benign Prostatic Hypertrophy may have really started his dry eye. Medically this is possible …or did the drug just tip his meibomian glands into “not working well enough for the new stressor in my life”?
When it comes to controlling insomnia, anxiety, depression, or suicidal ideation, it is important to treat these issue first so a patient can sleep and function normally (insomnia worsens dry eye) and then work on the dry eye issues afterwards, even though the drugs used to treat the former may worsen the dry eye. It is essential patients get the psychological help they need to function normally.
SLC
| Class | Examples |
|---|---|
| Antihypertensive agents (beta-agonists) | Acebutolol |
| Antihypertensive agent (alpha-agonists) | Atenolol |
| Antiarrhythmic agents (beta blockers) | Carvedilol |
| Labetalol Metoprolol Nadolol Pindolol Clonidine Prazosin Oxprenolol Propranolol |
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| Antipsychotic agents | Chlorpromazine |
| Fluphenazine Lithium carbonate Perphenazine Prochlorperazine Promethazine Quetiapine Thiethylperazine Thioridazine Brompheniramine Carbinoxamine Chlorphenamine (chlorpheniramine) Clemastine Cyproheptadine Dexchlorpheniramine |
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| Bronchodilators | Diphenhydramine |
| Antispasmodics/ antimuscarinic | Doxylamine |
| Antiarrythmic agents | Ipratropium |
| Atropine Homatropine Tolterodine Hyoscine (scopolamine) Hyoscine methobromide (methscopolamine) Disopyramide |
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| Antineoplastic agents | Busulfan |
| Cyclophosphamide Interferon (alpha, beta, gamma, or PEG) Vinblastine Cetuximab Erlotinib Gefitinib |
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| Antihistamines | Cetirizine |
| Desloratadine Fexofenadine Loratadine Olopatadine Tripelennamine |
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| Antidepressants | Citalopram |
| Fluoxetine Fluvoxamine Paroxetine Sertraline Diazepam |
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| Antileprosy agents | Clofazimine |
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| Antirheumatic agents/analgesics | Aspirin |
| Ibuprofen | |
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| Sedatives and hypnotics | Primidone |
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| Drugs secreted in tears | Aspirin |
| Chloroquine Clofazimine Docetaxel Ethyl alcohol Hydroxychloroquine Ibuprofen Isotretinoin |
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| Antiandrogens | Tamsulosin |
| Terazosin Doxazosin Alfuzosin |
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| Neurotoxins | Botulinum A or B toxin |
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| Antimalarial agents | Chloroquine |
| Hydroxychloroquine | |
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| Retinoids | Isotretinoin |
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| Antiviral | Aciclovir |
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| Thiazides | Bendroflumethiazide |
| Chlorothiazide Chlortalidone Hydrochlorothiazide Hydroflumethiazide Indapamide Methyclothiazide Metolazone Polythiazide Trichlormethiazide |
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| Cannabinoids | Dronabinol |
| Hashish Marijuana |
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| Chelating agents | Methoxsalen |
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| Strong analgesics | Morphine |
| Opium/opioids | |
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| Antipsychotic agents | Pimozide |
| Adjuncts to anesthesia | Antipyretic agents |
| Analgesics | Antirheumatic agents |
| Antiandrogens | Antispasmodics |
| Antiarrhythmics | Antivirals |
| Anticholinergics | Anxiolytics |
| Antidepressants | Bronchodilators |
| Antiemetics | Chelating agents |
| Antihistamines | Decongestants |
| Antihypertensives | Diuretics |
| Antileprosy agents | Neurotoxins |
| Antimalarial agents | Opioids |
| Antimuscarinics | Psychedelic agents |
| Antineoplastics | Retinoids |
| Antiparkinsonians | Sedatives and hypnotics |
| Antipsychotics |
References:
1. J Ophthalmol. 2012; 2012: 285851.
The Role of Medications in Causing Dry Eye
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
2. Curr Eye Res. 2017 Jun;42(6):827-831. doi: 10.1080/02713683.2016.1255758. Epub 2017 Jan 31.
Comparison of Autologous Serum Versus Preservative Free Artificial Tear in Patients with DryEyes Due to Systemic Isotretinoin Therapy.
In ophthalmology clinics, dry eye and ocular discomfort are most common presenting symptoms in the patients receiving isotretinoin.
http://www.dryeyepain.com/Practical1-Med_Surg.htm,
This is a nice summary also:
Which medicines can cause or increase dry eye?
| Drugs | Some People Report Possible Dry Eye Side Effect |
|---|---|
| Allergy medicines (antihistamines) | Can cause or worsen dry eye. This is true both for many eye drops used for seasonal allergies as well as for many or most over-the-counter allergy medicines. |
| Artificial tears (for some people) |
Can cause or worsen dry eye for some people if they contain preservatives or if you are sensitive or allergic to any of the ingredients. Currently, most artificial tears contain methylcellulose, and some people with dry eye are sensitive or allergic to methylcellulose. Be aware that an allergic reaction can occur days or weeks after you start using a new eye drop. |
| Anti-depressants | Some, including Diazepam (Valium) and Elavil, can cause or worsen dry eye. |
| Atropine | Can cause or worsen dry eye. |
| Beta blockers | Can cause or worsen dry eye. |
| Blood pressure medications | Can cause or worsen dry eye. |
| Cataract surgery eyedrops | Some people report an allergic or sensitive reaction to eyedrops used after cataract surgery. See alsoCataract Surgery. |
| Chemotherapeutic agents | Can cause or worsen dry eye. |
| Decongestants & decongestant eyedrops | Can cause or worsen dry eye. |
| Diuretics | Can cause or worsen dry eye. |
| Glaucoma eyedrops | Can cause or worsen dry eye. According to the Sjogren’s Syndrome Foundation newsletter, February 2002, “much of the damage to the eye surface [when using glaucoma eyedrops] is from the preservatives in the eyedrops; it is possible for some pharmacies to compound some of these agents in a non-preserved solution.” |
| Ibuprofen (Advil) | Can cause or worsen dry eye. |
| Incontinence medicines | Can cause or worsen dry eye. |
| Methylcellulose | Although methylcellulose is an ingredient in many, possibly most, artificial tears and other dry eye preparations, some people are allergic or sensitive to methylcellulose.
If you have tried many eyedrops but find that they don’t help or make your dry eye pain worse, try Refresh Lubricant Eye Drops (not the same as Refresh Plus, which does contain methylcellulose). The active ingredients in Refresh Lubricant Eye Drops are polyvinyl alcohol and povidone. You can find Refresh atMedShopExpress.com or Drugstore.com. |
| Murine eyedrops | Can cause or worsen dry eye. |
| Niacin | Can cause or worsen dry eye. |
| Oral contraceptives | Can cause or worsen dry eye. |
| Plaquenil (hydroxychloroquine) | Can cause or worsen dry eye for some individuals (sometimes prescribed for fatigue caused by Sjogren’s). |
| Provigil | Can cause or worsen dry eye (sometimes prescribed for fatigue caused by Sjogren’s). |
| Refresh Plus | Can make dry eye worse for people who are allergic or sensitive to carboxylmethylcellulose. Instead of Refresh Plus, try Refresh Lubricant Eye Drops (active ingredients: polyvinyl alcohol and povidone). Despite the similar names, Refresh Lubricant Eye Drops and Refresh Plus are completely different products. |
| Ulcer medications | Some can contribute to dry eye. |