Two well-known antidepressants are Zoloft (sertraline, Pfizer) and Paxil (paroxetine, GlaxoSmithKline). This can cause eye strain and dry eye, which may feel worse in the evening after a long day of work. In: GCY Chiou, ed. These eyedrops may improve symptoms by reducing tear evaporation. A review article in the Journal of Ophthalmology (online, Aug. 27, 2012) lists many such drugs and discusses this topic in detail. 2003 Apr. 12. Double or blurred vision. 17. But if someone is suffering from drug-induced dry eyes (or dry mouth), it is absolutely essential that this information be communicated to a physician to see if an alternative medication might not be appropriate that would not cause this adverse reaction. In general, these medications affect and reduce tear production (or more specifically, production of water that constitutes the aqueous layer) from the lacrimal glands, resulting in dryness of the eyes. National Academies Press, July 20, 2006. H2 receptor antagonists, like all antihistamines, can cause dry eye symptoms. Decreased meibomian gland function also impacts the production of the lipid layer of the precorneal tear film, leading to tear film instability and enhanced surface evaporation, which results in dry eye syndrome. www.optometric.com/article.aspx?article=70708 (Accessed April 2011). Share your own story about dry eyes below. It may seem like a minor annoyance to someone who doesn’t experience this symptom. Some of these procedures … Now consider what it would be like if you could not remove it and instead had a constant gritty, burning, scratching or stinging sensation that never goes away. Below is a non-exhaustive list of common medicines and drugs that can cause dry eyes … Pharmaceuticals that can cause dry eye symptoms include certain medications used to treat hypertension such as central-acting agents and diuretics; antihistamines and decongestants, in concert with anticholinergics; hormones; certain antidepressants; pain relievers, such as ibuprofen and lortab; and dermatologic agents. Boston: Butterworth-Heinemann, 1995:957- 1006. 1. Don’t run to the drugstore for eye drops. 20. This … They point out that the more medications a person is taking, the greater the likelihood that a combination could contribute to dry eyes. In general, these effects occur with OTC preparations—most commonly with Benadryl (diphenhydramine, McNeil Consumer) and Chlor-Trimeton (chlorpheniramine, Schering)—and in recent offerings, such as Claritin (loratadine, Schering). How to manage patients when systemic medications affect vision. Such a drip-by-drip solution is unlikely to alleviate the problem. Debra A. Schaumberg, Sc.D., O.D., M.P.H., and colleagues reported a 69% increase in dry eye symptoms in women who were taking estrogen compared to the control group.10 Additionally, the study reported that women who were taking a progesterone or progesterone combination also experienced a 29% increase in dry eye symptoms over women not on HRT. This medication class includes the proton pump inhibitors: Prevacid (lansoprazole, Takeda), Prilosec (omeprazole, Procter & Gamble), Nexium (esomeprazole magnesium, AstraZeneca), Zantac (ranitidine, GlaxoSmithKline) and Tagamet (cimetidine, GlaxoSmithKline). Phenothiazines are prescribed to manage schizophrenia. If a medication contributed to your symptoms, we would like to learn about that as well. Ampélas JF, Wattiaux MJ, Van Amerongen AP. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”, Eye drop preservative (benzalkonium chloride). 2008 Jan;145(1):60-73. Ophthalmic toxicity by systemic drugs. Hormone replacement therapy (HRT) with estrogens alone or in combination with progestins is a commonly prescribed therapy for post-menopausal women. Maturitas. Lemp MA, Baudouin C, Baum J, et al. 2001 Nov;286(17):2114-9. Diuretics. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. 2007;67(1):75-93. 3. Xiidra (ZYE-druh) is another prescription eye drop for dry eye treatment. A surprising number of drugs have what is referred to as anticholinergic activity. Optom Mgmt. 2006;5(5):467-8. Some of these medications are essential for good health. Xiidra Dry Eye Drops - Prescription only. Rennie IG. Jaanus SD. 2002 Jan;109(1):111-8. This incredibly unpleasant condition can be caused by a number of things. Fraunfelder FT, Fraunfelder FW. Lissamine green staining of conjunctiva and cornea in dry eye. CL Spectrum. 2. 14. Am J Ophthalmol. Boston: Butterworth Heinemann, 2001. Because this risk has been shown to increase with longer durations of estrogen use, patients on HRT with estrogens should be monitored for dry eye problems.11, Antidepressants Beta-blockers. 2000;35(2):92-6. Approximately 20% of previously successful contact lens wearers may need to decrease their wearing time, use preservative-free lubricating eye drops or discontinue contact lens wear while on this medication.18. 10. Patients need to assume some responsibility here as well. Symptoms of blurred vision, cycloplegia and dry eye are transient and reversible.7. Hypertensive Agents Perhaps none is more current and readily available than Epocrates (www.epocrates.com), which is updated weekly can be downloaded to your mobile device. In: Bartlett JD & Jaanus SD (eds.). The exact cause-and-effect relationship is unknown, but may be associated with a decreased aqueous component of the precorneal tear film.9. Hom M. Is it the medication? Ophthalmology. They need to know the brand names and generic names of the medications they are taking. 2003;18(4) . The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye Workshop (2007). We NEVER suggest that a patient stop taking a medication without first checking with the prescriber. High Blood Pressure. D ry eye is a multi-factoral disease of the tears and ocular surface; one such factor is the patient’s use of systemic medications.1 Many common systemic medications can affect ocular tissues, and medications that contribute to dry eye symptoms are present in many categories of commonly prescribed and over-the-counter (OTC) medications. Preventing Medication Errors: Quality Chasm Series. 19. 11. Optom Mgmt. Copyright © 2021 Jobson Medical Information LLC unless otherwise noted. He is also a diplomate in the Primary Care Section of the American Academy of Optometry. Fortunately, there are many resources available to help us with this information. Chemotherapy Medications Topiramate (Topamax) is used for the treatment of seizure disorder, migraine headache, and mood … Of our patients who take six or more medications a week, at least half receive prescriptions from three or more physicians!3. Treatment will be different for each person depending on the root cause of the dry eye. There are various ways that medications contribute to dry eye syndrome. Here are the broad categories and specific medications that have been known to potentially … Two useful resources in clinical practice are “Clinical Ocular Toxicology: Drug Induced Ocular Side Effects” by Frederick Fraunfelder, M.D., and Wiley Chambers and “Clinical Ocular Pharmacology,” 5th edition by James Bartlett, O.D., D.O.S., M.Sc., and Siret Jaanus, Ph.D., L.H.D. According to one estimate, four out of every five U.S. adults will use prescription medicines, over-the-counter drugs or dietary supplements in any given week, and nearly one-third of adults will take five or more different medications in the same timeframe.2 Older patients may be at greater risk for medication side effects because they often take multiple prescription medications. 18. Tears can be inadequate for many reasons. Antidepressants, Psychosis, and … As eye care providers, we can be valuable in detecting ocular side effects of systemic medications, advising our patients and communicating with other members of our patients’ healthcare teams. 1993 Sep;9(3):196-211. Prolonged contact lens use. But just ask anyone who suffers from dry eyes what it feels like and you will hear some serious woe and misery. Santaella RM, Fraunfelder FW. Erdem U, Ozdegirmenci O, Sobaci E, et al. 8. In this article we will discuss several categories of pharmaceuticals, each containing medications that can produce dry eye symptoms. Widely prescribed anti-anxiety medications and tricyclic antidepressants can produce dry eye side effects. Medications that can cause this include Adipex (for obesity), Celebrex (inflammation), Lamictal (seizures), Mevacor (elevated cholesterol), Tylenol (pain ­relief) and Zantac (ulcers). Schornack JA. A major drug in this class is Cytoxan (cyclophosphamide, Bristol-Myers Squibb), which is also used to treat ocular cicatricial pemphigoid and primary Sjögren syndrome. Available at: “These drugs can also cause central serous retinopathy, which is a collection of fluid in the macula in the back of the eye, and they can cause subconjunctival hemorrhages,” he says. Scheinfield N, Bangalore S. Facial edema induced by isoretinoin use: a case and review of the side effects of isoretinoin. 13. While these drug categories are the most common offenders in producing dry eye problems, exceptions exist in every drug category. List of drugs associated with a side effect named as Blurred Vision and related drug information. Drugs. That may be because it doesn’t seem like such a big deal, especially compared to serious side effects like liver or kidney damage, heart attack or stroke. Identify the ocular side effects of systemic medications. Imagine sandpaper under your eyelids. Antihistamines are combined with anticholinergics in many OTC medications, such as cold preparations, sedatives, antidiarrheals and nasal decongestants.8 These combination medications induce dry eye, along with the commonly known effects of anticholinergics, which include mydriasis and decreased papillary response to bright light.8, Hormones No one can possibly remember all of the potential ocular adverse events associated with each medication. Optom Mgmt. Dry eye complaints will disappear after medication use is discontinued, although it may take several months for the complaints to wane. Physicians prescribe systemic beta blockers to treat angina pectoris, essential hypertension, myocardial infarctions and migraine headaches.4 Beta blockers reduce lysozyme levels and immunoglobulin A, causing a decrease in aqueous production and subsequently leading to symptoms of dry eye.5 Patients using beta blockers also exhibit corneal anesthesia, decreased tear film break-up times and ocular irritation. Ocular side effects of selected systemic drugs. The effect of these medications, however, is not as profound as earlier generation antihistamines. Dry eyes can be caused by reduced tear production or increased evaporation from the eye's surface, but doctors rarely mention dry eyes as a drug side effect. 7. 6. 1. Xiidra® (lifitegrast ophthalmic solution 5%) became FDA … If you have found a solution, please share your success story with others. Isotretinoin (13-cis-retinoic acid) is a form of vitamin A that reduces the amount of oil released by oil glands in the skin.15 Vitamin A and its synthetic derivatives are collectively known as retinoids and are used to treat severe recalcitrant nodular acne, acne vulgaris and severe recalcitrant psoriasis, and to induce remission of leukemia.16 Isoretinoin has been shown to be secreted in tears by the lacrimal gland and has been associated with causing meibomian gland dysfunction—producing dry eye complaints, contact lens discomfort, blepharoconjunctivitis, transient blurring of vision and acute, transient refractive changes––especially myopic shifts.17 This synthetic medication affects the overproduction of skin lipids. A surprisingly large number of drugs have the potential to trigger this complication. This can lead to dry eyes in rheumatoid arthritis, lupus and Sjogren’s syndrome. When selecting reference resources, choose those that are complete and updated frequently. Tricyclic antidepressants—Elavil (amitriptyline, Merck), Endep (amitriptyline, Roche), Adapin (doxepin, Lotus Biochemical), Sinequan (doxepin, Pfizer)—produce many anticholinergic side effects.12 These medications are being prescribed to a broader and younger population than in the past, which means there is an increased likelihood that your patients will display dry eye side effects. 2nd ed. Antipsychotic Drugs, Antidepressants and Parkinson’s Medications Can Cause Dry Eye. 2. So may novel psychoactive substances such as synthetic opioids (Helander et al, British Journal of Dermatology, April 2017). Ocular adverse effects associated with systemic medications. 4. 16. Penicillins can cause … Tests and procedures that may be used to determine the cause of your dry eyes include: 1. Further study is needed, but some alternative medicine approaches may help relieve your dry eye symptoms. 2007;56(3):257-62. As many as 60% of patients taking cyclophosphamide have developed dry eye.19, Antipsychotic Medications Dermatologic Medications Pain Relievers Do not consider this brief discussion exhaustive, as many other drugs and categories may have dry eye as a side effect. If you have dry eyes, your eyes may sting or burn. Optom Clin. Birth control pills. The newer, more site-specific (H1 selective) antihistamines like Zyrtec (cetirizine, McNeil Consumer), Clarinex (desloratadine, Merck) and Allegra (fexofenadine, Sanofi-Adventis) are less likely to cause ocular dryness, but they may affect the tear film. Xiidra (Shire), like … Antibiotics taken orally have been known to cause dry eyes. Some people begin to experience dry eye after laser vision correction surgery. Hydrochlorothiazide (HCTZ) is a commonly used diuretic and can produce changes in the precorneal tear film, inducing a dry eye.6 Furosamide and HCTZ/triamterene are other common medications in this class. 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