A surprisingly large number of drugs have the potential to trigger this complication. Available at: List of drugs associated with a side effect named as Blurred Vision and related drug information. Treatment will be different for each person depending on the root cause of the dry eye. In some people the immune system attacks the tear glands just as it destroys other body tissue. Hormone replacement therapy (HRT) with estrogens alone or in combination with progestins is a commonly prescribed therapy for post-menopausal women. Thiazides or diuretics are often prescribed to treat congestive heart failure. National Academies Press, July 20, 2006. Such drugs can cause both a dry mouth and dry eyes by interfering with glands in these organs. Common Medication Examples. Dry eye in post-menopausal women using hormone replacement therapy. 5. Double or blurred vision. 2007;56(3):257-62. If a medication contributed to your symptoms, we would like to learn about that as well. These eyedrops may improve symptoms by reducing tear evaporation. There are various ways that medications contribute to dry eye syndrome. 2001;27(6):588-99. 4. 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). This … Antidepressants. When selecting reference resources, choose those that are complete and updated frequently. The effect of these medications, however, is not as profound as earlier generation antihistamines. 2003;18(4) . Do not consider this brief discussion exhaustive, as many other drugs and categories may have dry eye as a side effect. 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. 2006;5(5):467-8. Dry eye complaints will disappear after medication use is discontinued, although it may take several months for the complaints to wane. Ophthalmic toxicity by systemic drugs. These are available as supplements and in foods such as flaxseed, salmon and sardines. The exact cause-and-effect relationship is unknown, but may be associated with a decreased aqueous component of the precorneal tear film.9. Pain Relievers Here are the broad categories and specific medications that have been known to potentially … At the end of the day, it is our responsibility to make sure that our patients know how their systemic medications could be contributing to their ocular surface disease. Medications that block histamine receptors alleviate allergic conditions of rhinitis, uticaria, dermatitis and systemic allergies. “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. Imagine sandpaper under your eyelids. 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. 18. Topiramate (Topamax) is used for the treatment of seizure disorder, migraine headache, and mood … A great deal of information is available about hormone replacement therapy in post-menopausal women. Fraunfelder FT, Fraunfelder FW, Edwards R. Ocular side effects possibly associated with isotretinoin usage. They need to know the brand names and generic names of the medications they are taking. Optom Clin. Jasper A. Physicians and pharmacists rarely mention dry eyes as a drug side effect. Such a drip-by-drip solution is unlikely to alleviate the problem. 19. It may seem like a minor annoyance to someone who doesn’t experience this symptom. Except for brinzolamide, all CAI s are … 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. They point out that the more medications a person is taking, the greater the likelihood that a combination could contribute to dry eyes. Ocular adverse effects associated with systemic medications. Antidepressant & Parkinson’s Medications Any prescription medication with a nerve-inhibiting quality has the potential to cause dry eye symptoms. … We NEVER suggest that a patient stop taking a medication without first checking with the prescriber. 2009 Nov;24-58. You may experience dry eyes in certain situations, such as on an airplane, in an air … 7. In: GCY Chiou, ed. Mellaril (thioridazine, Mutual Pharmaceutical) is the best known of this class and has almost completely replaced Thorazine (chlorpromazine, GlaxoSmithKline) in the management of the condition. Of our patients who take six or more medications a week, at least half receive prescriptions from three or more physicians!3. Maturitas. Castor oil eyedrops. 16. Two well-known antidepressants are Zoloft (sertraline, Pfizer) and Paxil (paroxetine, GlaxoSmithKline). Jaanus SD, Bartlett JD, Hiett, JA. 6. high blood pressure medication, such as diuretics and beta-blockers Some of these procedures … Erdem U, Ozdegirmenci O, Sobaci E, et al. 2001 Sep;132(3):299-305. Hypertensive Agents People are surprised to learn that even non-prescription medications could be contributing to their uncomfortable eyes. Dermatologists sometimes prescribe Accutane (isoretinoin, Genpharm) for the treatment of recalcitrant acne. Wearing lenses for too long during the day can make dry eye … While these drug categories are the most common offenders in producing dry eye problems, exceptions exist in every drug category. 8. This drug class causes decreased lacrimation, which may induce dry eye complaints. Scheinfield N, Bangalore S. Facial edema induced by isoretinoin use: a case and review of the side effects of isoretinoin. 12. 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. Chemotherapy Medications Popular medicines like Zoloft (sertraline) and Paxil (paroxetine) belong to a different class of antidepressants, called selective serotonin reuptake inhibitors (SSRIs). Your doctor may measure your tear production using the Schirmer test. Dermatologic Medications Measuring the volume of your tears. This can cause eye strain and dry eye, which may feel worse in the evening after a long day of work. Phenothiazines are prescribed to manage schizophrenia. This report, based on observations on 25,000 post-menopausal women, showed evidence of a significant increased risk of dry eye syndrome and severity of dry eye symptoms in women taking estrogen. Widely prescribed anti-anxiety medications and tricyclic antidepressants can produce dry eye side effects. Ophthalmology. That is why diabetes, herpes eye infection and laser eye surgery (LASIK) may sometimes result in dry eyes. 9. Skin Medications Medications … Antihistamines. 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 2008 Jan;145(1):60-73. High Blood Pressure. 2007;67(1):75-93. 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. Bowling is in private group practice in Tuscaloosa, Ala. But just ask anyone who suffers from dry eyes what it feels like and you will hear some serious woe and misery. “Many doctors think erectile dysfunction drugs cause … A surprisingly large number of drugs have the potential to trigger this complication. Optom Mgmt. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye Workshop (2007). These include diuretics (water pills), antihistamines, antidepressants, drugs that lower cholesterol, beta-blockers and birth control pills. 2nd ed. Dry eyes can be triggered by reduced tear production or increased evaporation from the surface of the eye. Psychiatric manifestations of lupus erythematosus systemic and Sjögren’s syndrome. Call your doctor. 1981;52(3):257-8. Xiidra (ZYE-druh) is another prescription eye drop for dry eye treatment. Antidepressants Antidepressants and anti-anxiety medications also can produce dry eye symptoms. 3. Recommend your patients use only one pharmacy so the pharmacist can help monitor for drug interactions. That means they affect the way the neurochemical acetylcholine interacts with receptors in the body. Boston: Butterworth-Heinemann, 1995:957- 1006. Such drugs can cause both a dry mouth and dry eyes by interfering with glands in these organs. 15. Ocular side effects of selected systemic drugs. No one can possibly remember all of the potential ocular adverse events associated with each medication. Certain classes of drugs are known to cause eye problems. As always, the best course is to educate our patients about the role their medications play in their dry eye complaints. He is also a diplomate in the Primary Care Section of the American Academy of Optometry. Schornack JA. Cequa (cyclosporine) is a drug that is a part of the CNI Immunosuppressants class and treats dry eyes.CNI immunosuppressants are used to treat organ transplant rejection, rheumatoid arthritis, psoriasis, dry eyes… 3. Birth control pills. Bartlett JD. Symptoms of blurred vision, cycloplegia and dry eye are transient and reversible.7. What’s more, treating drug-induced dry eyes with eye drops might be a little like trying to slake your thirst in the middle of the desert with an eye dropper of water. How to manage patients when systemic medications affect vision. 1. Penicillins can cause … Prolonged contact lens use. 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. Hormone replacement therapy and dry eye syndrome. Beta-blockers. This has a serious impact on quality of life and explains why some people may be dissatisfied with the outcome of their LASIK surgery. Bergmanson JP, Rios R. Adverse reaction to painkiller in hydrogel lens wearer. Muchnick BG. 1992;2(4):73-96. Xiidra (Shire), like … … Fatty acids. 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. This incredibly unpleasant condition can be caused by a number of things. Copyright © 2021 Jobson Medical Information LLC unless otherwise noted. A comprehensive eye exam. These are available as eye drops [Trusopt® (dorzolamide), Azopt® (brinzolamide)] as well as pills [Diamox (acetazolamide) and Neptazane® (methazolamide)]. Identify the ocular side effects of systemic medications. Rennie IG. Even though Roche Pharmaceuticals pulled Accutane from the market in 2009, generic versions of the drug may still be available by prescription. Both drugs decrease aqueous secretion, and symptoms are transient and dose dependent.20. Clinically important ocular reactions to systemic drug therapy. But just ask someone with dry eyes how it affects their quality of life, and you will quickly learn that this is not a minor complication. Some of these medications are essential for good health. The use of estrogen replacements and contraceptive agents is commonly implicated in dry eye. Xiidra. Thioridazine … Antidepressants, Psychosis, and … 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). Brand name examples include Zoloft, Paxil, Elavil, Endep and Sinequan. CL Spectrum. 2. 14. Further study is needed, but some alternative medicine approaches may help relieve your dry eye symptoms. 2000;35(2):92-6. Optom Mgmt. 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. Rev Optom. 5th ed. J Drugs Dermatol. Schaumberg DA, Buring JE, Sullivan DA, et al. So may novel psychoactive substances such as synthetic opioids (Helander et al, British Journal of Dermatology, April 2017). 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). 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 Lissamine green staining of conjunctiva and cornea in dry eye. In: Bartlett JD & Jaanus SD (eds.). Dry eye is often a side effect of certain medications. 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. Antihistamines and Decongestants Antibiotics taken orally have been known to cause dry eyes. 13. Michigan: Taylor and Francis, 1999:225-83. Hom M. Is it the medication? Perhaps none is more current and readily available than Epocrates (www.epocrates.com), which is updated weekly can be downloaded to your mobile device. Institute of Medicine, National Academies. 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. Conditions that reduce the cornea’s sensitivity reduce blinking and tear production, too. H2 receptor antagonists, like all antihistamines, can cause dry eye symptoms. Cholesterol -lowering drugs. 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