Methadone and Dry Eye


Many drugs list “Dry Eye” as a potential side effect. Some of these drugs are directly toxic to eyelid/gland structures that produce part of the tear. It appears from our evaluation on meibography & Schirmers tests that the following drugs are the worst offenders in damaging cells:

1. Accutane: appears to directly can destroy meibomian gland function & lacrimal gland

2. Anti-cholinergic drugs: directly decrease chemical involved in producing tears in lacrimal gland

3. Anti-hypertensive meds

4. AntidepressantsChemotherapeutic drugs: directly kill meibomian and lacrimal gland cells (likely also goblet cells).

All other drugs have the potential to dry out the eye more, but sometimes the benefits outweigh the risks:

methadone meibomian gland

Methadone is a full μ-opioid receptor agonist that has been reported to be associated with decreased tear film in dogs, but the exact mechanism is not clear. Pubmed to date has no papers on a search for “Methadone and Lacrimal gland,” and no papers on “Methadone and Meibomian gland.”

Methadone’s use in some cases may necesitate the risk of worsening dry eye. 


Good review of Illicit drugs that affect the eye.

Wolters Kluwer — Medknow Publications

Illicit drugs: Effects on eye

Deepika Dhingra, Savleen Kaur, and Jagat Ram

Additional article information


There is a myriad of changes that can be produced in the eye by toxic drugs ranging from mild/no symptoms to severe loss of vision from endophthalmitis. The routes of administration include oral ingestion, smoking, nasal inhalation, intravenous injection, topical application or application to other mucosal surfaces. It is important to recognize certain clinical signs and symptoms in the eye produced by these toxins. This article describes in brief some of the ocular effects of commonly abused drugs. For identification of a particular poisoning, in addition to the clinical presentation, pulse, blood pressure, respiration and body temperature, pupillary size, pupillary reaction to light, ocular convergence and nystagmus can be useful indicators of the type of drug the patient is exposed to. Unmasking these features help the clinician in an early and accurate diagnosis of the offending drug as well as timely management.

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