The People's Perspective on Medicine

Drugs That Can Cause Dry Eyes

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.
Medicine healthcare liquid eyedropper on human eye

It may seem like a minor annoyance to someone who doesn’t experience this symptom. But just ask anyone who suffers from dry eyes what it feels like and you will hear some serious woe and misery.

Imagine sandpaper under your eyelids. If you have ever gotten a foreign object in your eye you know how distressing that can feel until you get it out. 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.

What Causes Dry Eyes?

This incredibly unpleasant condition can be caused by a number of things. Dry eyes can be triggered by reduced tear production or increased evaporation from the surface of the eye. In some people the immune system attacks the tear glands just as it destroys other body tissue. This can lead to dry eyes in rheumatoid arthritis, lupus and Sjogren’s syndrome.

Conditions that reduce the cornea’s sensitivity reduce blinking and tear production, too. That is why diabetes, herpes eye infection and laser eye surgery (LASIK) may sometimes result in dry eyes. In certain cases, this reaction may be severe and can last for months or even years. This has a serious impact on quality of life and explains why some people may be dissatisfied with the outcome of their LASIK surgery.

Drugs Can Also Contribute to Dry Eyes:

Physicians and pharmacists rarely mention dry eyes as a drug side effect. 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. 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. 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. Such a drip-by-drip solution is unlikely to alleviate the problem.

There are various ways that medications contribute to dry eye syndrome. A surprising number of drugs have what is referred to as anticholinergic activity. That means they affect the way the neurochemical acetylcholine interacts with receptors in the body. Such drugs can cause both a dry mouth and dry eyes by interfering with glands in these organs. A surprisingly large number of drugs have the potential to trigger this complication. A review article in the Journal of Ophthalmology (online, Aug. 27, 2012) lists many such drugs and discusses this topic in detail. They point out that the more medications a person is taking, the greater the likelihood that a combination could contribute to dry eyes.

Some Drugs That May Induce Dry Eyes

  • Atenolol
  • Atropine
  • Brompheniramine
  • Carvedilol
  • Cetirizine
  • Cetuximab
  • Chlorothiazide
  • Chlorpheniramine
  • Chlorpromazine
  • Citalopram
  • Clemastine
  • Clonidine
  • Cyclophosphamide
  • Cyproheptadine
  • Desloratadine
  • Diphenhydramine
  • Doxazosin
  • Doxylamine
  • Eye drop preservative (benzalkonium chloride)
  • Fesoterodine
  • Fexofenadine
  • Fluoxetine
  • Fluphenazine
  • Fluvoxamine
  • Furosemide
  • Homatropine
  • Hydrochlorothiazide
  • Hyoscine
  • Ibuprofen
  • Indapamide
  • Interferon
  • Ipratropium
  • Isotretinoin
  • Labetalol
  • Lithium
  • Lithium
  • Loratadine
  • Metoprolol
  • Nadolol
  • Naphazoline
  • Oxprenolol
  • Oxybutynin
  • Paroxetine
  • Pindolol
  • Prazosin
  • Primidone
  • Prochlorperazine
  • Propranolol
  • Quetiapine
  • Sertraline
  • Tamsulosin
  • Terazosin
  • Thioridazine
  • Timolol (topical)
  • Tolterodine
  • Tripelennamine
  • Tropicamide
  • Vinblastine

Recent case reports suggest that herbal medicines may also be responsible for severe dry eyes (Oh et al, Clinical and Molecular Hepatology, Sep. 2013). So may novel psychoactive substances such as synthetic opioids (Helander et al, British Journal of Dermatology, April 2017).

We NEVER suggest that a patient stop taking a medication without first checking with the prescriber. Some of these medications are essential for good health. 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.

Share your own story about dry eyes below. If you have found a solution, please share your success story with others. If a medication contributed to your symptoms, we would like to learn about that as well.

Revised May 10, 2018

Rate this article
star-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-emptystar-fullstar-empty
4.4- 30 ratings

Today's Newsletter Reading List

    About the Author
    Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. 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. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
    Tired of the ads on our website?

    Now you can browse our website completely ad-free for just $5 / month. Stay up to date on breaking health news and support our work without the distraction of advertisements.

    Browse our website ad-free
    Join over 150,000 Subscribers at The People's Pharmacy

    We're empowering you to make wise decisions about your own health, by providing you with essential health information about both medical and alternative treatment options.

    Showing 44 comments
    Comments
    Add your comment

    After reading all these comments plus reading up on which medications potentially cause dry eye, I have now come to the conclusion that I developed this horrible condition not long after I started taking anti depressants regularly some 7 + years ago!
    I am now going to try and ween myself off this medication in the hope that the dry eye condition may improve or maybe disappear altogether ! My eyes are watering constantly, they are red, sore and feel gritty most of the time! I have not been able to wear eye makeup for years. I really look forward to getting into bed at night and putting in my Lacrilube and closing my eyes, it’s truly the only time they feel reasonably comfortable.
    Will update as and when I have any further comments to add to this site.

    Ppi’s cause dry mouth and dry eye! Terrible to have to choose between reflux pain and dry eye! Caught between a rock and a hard place ?

    I suffer from dry sore eyes from my heart meds and as I need them I had to find a solution I bought eye drops and eye gel the latter for at night but although they relieved the problem a bit they were still very dry and painful. Then I decided to drink more water and ease up on caffeine etc and it really has helped I actually did not realise how little fluids I was taking I also started to blink more strange as it sounds I actually do not blink a lot so that is the quickest way to moisturize my eyes especially when out and about I reduced my screen time to rest my eyes and increased my omega 3 intake. When my eyes feel tired I use green tea bags on the lids and that really soothes the lids

    is there a difference in term of dry eyes frequency and gravity between the different systemic betablockers particularely between cardioselective or not

    thanks

    It is sad that in 2017 there is no cure fore this because it is miserable.

    I have always had a water softner
    When I moved to a northern town I got one for there.
    My husband set the setting way too soft.
    It burnt my eyes. At least felt like it..
    Ever since my eyes are worse than ever.
    That was over a year ago.
    My eye dr does not think this is the cause.
    Have to wear goggles in the shower now.
    Pantenol drops before and after shower. Softner set on one now.
    You have to have a softner here.

    Right eye started to feel sticky about a month ago and it often felt like a hair of grain of sand was under the eyelid. 2 weeks ago I realized my right eye had gotten lazy, staying out of focus until I covered my left eye. Symptoms seem worst in the evening and my left eye was started to show symptoms. That’s when I started to worry and seriously thinking about possible causes. I realized that I started taking antihistamines, ibuprofen and a sleep aid on a regular basis about 3 months ago to deal with sinusitis, headaches and insomnia. I stopped taking all medication about 1 week ago and the symptoms have already reduced dramatically.

    Two of my blood pressure medications are on your list. The meds also indicate dry eyes (and mouth) are side affects. Doctors haven’t found other drugs to replace these two. I have very sensitive nervous system and all the other drugs make me very sick in many ways. So my question is : is their any other thing I can do for my dry eyes and mouth – it is very difficult to function when your eyes are so dry you cannot see adequately or even get your eyes open in the morning. I use a salve in the evening when I go to sleep which is prescribe by my ophthalmologist but it is not an adequate solution. I am searching the internet for anything that might help. Does this website have any solutions for me. Thank you.

    I got bit by my cat the first week of august, one tooth broke the skin and it got ugly red… the doctor gave me antibiotics oral and an antibiotic injection plus a tetanus shot. As I discovered cat bites can cause serious infections. 5 days later, after the shots my eyes became so incredibly dry and blood shot and in one eye my vision for close up is now completely blurry like overnight when i got the dry eye…i could see fine in my close up vision before… i went to the dr and they checked my for lyme disease, bartonella from the cat bite and they checked for lupus and sjogrens syndrome plus some other things, which came back negative…I have almost no tears and it just will not go away….sometimes i have a dry mouth also..i have been having headaches and sleep problems i did not have before. It is very frustrating… every morning i wake up and hope somehow my eyes will go back to the way they used to be…pretty convinced it is the shots or there is something else in my cats bite beside bartonella… I read some antibiotics can upset the fluid balance in the eye…I don’t know if that is true…i use a bead filled eye mask that i can warm in the microwave…and i like genteal gel…Its the end of October now and still no improvement….

    I have had severe dry eyes now for a year, I have spent over $1000 on this wretched disease.
    I have had numerous eye drops, doxycycline antibiotics, plugs in my tear ducts to stem the flow of tears and now 3 bouts of E laser treatment to stimulate the Mebomian glands to make more oil. I have tried castor oil as well and still no joy with anything.

    I have been on prazosin for 4 days ( 1 mg) and I knew I’d be lightheaded but today I have burning eyes and heart palpitations….normal or ER??

    My dry eyes are from a medication for epilepsy. I have tried a lot of remedies and what works best for me is SeaBuckthorn, which is a fruit oil. I take one capsule per day and I find it well worth the price.
    Darlene

    Relieved to know that I’m not alone. Up until I was started on Norvasc by my primary caretaker in July, in addition to the Lisinopril and HCTZ I was already taking, I’d had no problems with dry eyes. An optometrist recommended Celluvisc at night. However, a severe dry eye in November sent me on an ED visit and I was seen by an ophthalmologist, diagnosed with a corneal abrasion to my L eye. He has since followed up after inserting a ‘bandage’ contact lens and starting me on an antibiotic and hyper saline drops to reduce corneal swelling. I’m going to ask him about the medications and if they are responsible for what’s happened. The Celluvisc is used at night. Otherwise, no problems during the day.

    I have also had the irritating, “sand paper” feeling in my eyes, especially in the evening. I recently asked my eye doctor about it and she suggested wetting a washcloth with very hot tap water, wringing it out and placing it over my eyes for a couple of minutes. The warmth brings out the natural oils in the eye and provides great relief. Simple, chemical free, inexpensive!

    The aromatase inhibitors used in breast cancer are associated with side effects that include dry eyes, dry skin and other areas of dryness. And multiple other side effects, I might add.

    I recently have had itchy eyes and it is getting worse esp in one eye. It does seem like the worse eye has no fluid from the duct next to my nose. I recently started on 2 drugs
    I never had before – flagyl and praluent. When the flagyl is done I will see if the eye gets better.

    I don’t see anyone in these comments mentioning ocular rosacea. I have rosacea (inherited) so I have blamed my dry eyes on this condition. My ophthalmologist did not diagnosis this – I did after research on the internet, but he agrees with me that this is probably the cause of my dry eyes – one eye significantly worse than the other.

    I have had extreme discomfort for years with dry eye disease. My eye doctor prescribed Restasis, twice daily, Systane Ultra, and Systane Gel drops. The blood vessels in my eyes are red most days, and when my eyes are not bloodshot they still feel scratchy and irritated, burning and itching sometimes. I have not tried Evening Primrose Oil and drinking lots of water. I appreciate that I am not alone with this miserable disease, and it helps to hear approaches others take concerning this problem.

    I have over active bladder. Dr suggested a new drug called Myrbetriq (mirabegron) adrenergic receptor type drug… It worked well until 1 yr later. Dry eyes. I think the drug S L O W L Y killed the way the lacrimal gland produces tears/moisture. I didn’t put 2 & 2 together until 6 months later. 8 eye drs , an endocrinologist, & infectious disease dr with no answers…it must be the drug. I stopped September 18, 2014 and I am still waiting for my lacrimal glands to rejuvenate. I called a lawyer..no help..I called & advised the FDA and Astellas Pharma drug company. Nothing. Watch out for side effects of all drugs!! Less is better!!!

    Lots of good information here. After 2 years or dry eyes and multiple eye doctor visits and trials of drugs, I think my dry, burning, itchy eyes were caused by Atenolol.

    Did your tears come back after stopping the drug? How long did it take?

    I just found out about five years ago that I have high blood pressure. So my doctor put me on a diuretic and I have been using it ever since once a day. Triamterene -HCTZ is the name of it and before I was taking another one but it stripped my potassium levels too much. Now I take a potassium supplement with this one. I started noticing dry eye symptoms about a couple years ago when I would wake up with terrible pain in my eye and a gritty feeling that just would not go away. I thought it was dirt in my eye or allergies. I also had shingles in 2012 on my face and yes in my eye but the eye doctor told me it had not affected my sight. I had an exam year and half ago for new glasses and was told my eye’s had actually improved and that I had dry eye. The other day I went for an eye exam due to blurry vision that had started about a couple of weeks ago and am now told that I have cataracts in both eyes!! I am scheduled to see a specialist next month to find out what is really going on with my eyes. I have never had dry eye or any problems except nearsightedness so I am devastated at this point.. I wonder if my meds are causing this.

    Vyvance causes dry eye and mouth. It’s worth it for me but it is uncomfortable and makes me feel tired and even interferes with getting to sleep. I don’t have a solution yet.

    Hi all,
    I thought I would share my success story, a very simple dry eye cure that worked for me :))
    I used to have mild dry eyes for close to 10 years. A little annoying at times and drops did help soothe of which I only used a couple of times a week.
    4/5 months ago (mostly in one eye, my weakest) my eye was so red and sore from dry eye that drops did not work. My eye was classed with severe dry eye by my doctor.
    He gave me a script of drops that would help with the redness but this only made them worse and stung like mad.
    He referred me to an eye specialist however I did not end up going.
    I searched high and low for natural ways on the internet but didn’t really get anywhere as they all recommended different things and they were very confusing.
    Seeing I needed new glasses and time for another eye test I thought I would visit the optometrist and see if he can help me.
    Before I said anything to him he took one look at my eye and asked me how much fluid was I drinking?…. the answer was 1 maybe two glasses a day along with umpteen cups of coffee.
    His advice – Hydrate your body, WATER, milk, organic teas as your organs take at least 6-8 weeks to get fully hydrated.
    He also said to me that the over the counter dry eye drops sometimes make your eyes worse and that there is really only one cure.
    The first couple of weeks were the hardest, not being used to drinking so much water. I gave up coffee of which I feel more enegised anyway and drank loads of water and organic teas.
    Start off with drinking at least a litre of water a day and by week 2/3 you should be drinking 3.3 divided by your weight.
    I noticed a big difference by the 6th week and by week 10 which is now “I NO LONGER HAVE DRY EYE”… It took a little longer for me being so dehydrated however i persevered with it..
    Who would think that such a simple thing like keeping your body hydrated would cure dry eye… makes very good sense now of course.
    If anyone does try this I would be grateful to know how you went…Please be patient with this process and keep me posted :)

    kEz KeZ kEz KeZ kEz KeZ

    Hydration is always good, but you also must be careful not to drink too much water since you can deplete your body of needed nutrients, vitamins, and minerals as your body gets rid of all the fluid you are taking in. I also didn’t understand your equation: i.e., 3.3 divided by your weight. Does that give you the number of ounces of water/fluids you should get every day? Do you divide 3.3 by your weight or your weight by 3.3? Confusing.

    I never had any problem with dry eyes until this past year when, after being Dx’ed with atrial fibrillation, I had to take Warfarin (Coumadin) and Sotalol, a beta-blocker. Within a short time my eyes were so dry on awakening that some days I literally had to massage the eyelid off the eyeball with my fingers!
    During this time my visual acuity just fell off a cliff. I’d had a refraction just a year earlier and had had perfect (corrected) vision. Went to the ophthalmologist, who said I now had cataracts in both eyes!
    I absolutely blame the dry eyes and the medication. Now I’m off those meds, and no more dry eyes! The cataracts are getting repaired. But have you ever heard of dry eyes causing cataracts?

    I had “after cataract surgery” recently and have had dry eyes (sandpaper) every since. It is not terrible–I do not feel it all the time–but it is annoying. My Opthamologist prescribed an antibiotic, but I did not take it because I have debilitating SIBO and need to take as few antibiotics as possible. Also, I didn’t believe a temporary antibiotic would relieve a chronic condition permanently.

    Do you put the castor oil in eye or on eyelid?

    I’m so happy that you have addressed this problem with dry eyes. I have dealt with this problem for ten years. Nothing I have used topically or orally has helped the problem. I also have the tear duct plugs which haven’t worked that great. I have glaucoma and use drops for that three times daily which makes the problem worse.
    I have never found an eye drop, even the preservative free ones that worked more than five minutes. I take Fish oil capsules three times daily which hasn’t helped that much, and metformin for diabetes. I also use Armour thyroid for hypothyroidism.
    Some have wrote about using Castor oil in the eyes for this problem. Would this be safe to try?If anyone has any suggestions of what to use, it would be greatly appreciated. This problem has made my life miserable.
    People’s Pharmacy response: We would caution against putting castor oil in your eyes unless your doctor suggested it. It sounds as though you have a fairly complicated eye situation, and we would hate to have you make it worse with an over-the-counter drug not intended for this purpose.

    Starting after my Lasik surgery, I too had such extremely dry eyes, and eye duct plugs kept working out and scratching my eyeball, so they were removed. I could not open my eyes after sleeping without tearing them from the eyelids.
    My solution was to think of something very sad, like the loss of one of our beloved pets, which flooded my eyes with that type of tears. It could be the plight of any persons near or far that you empathize with, & shed some tears about.
    Love for humanity always being good.

    I do the same thing
    Cry
    It helps for a short time after.

    Check side effects for your Glaucoma medication. I was using Xalatan and didn’t know that dry eye was a side effect of it and since I already had dry eye eventually it got worse. My new Optometrist took me off of it and now I am not using anything. Don’t know why my previous one had put me on it. My pressure is now 11 in each eye and I have been off for almost a year. At the time he took me off of it I was having a very bad dry eye issue that lasted for 4 days. Finally got it stopped using Refresh liqui-gel every night and Tears Natural in the day and I am sure that stopping the Xalatan had a lot to do with it also, as my attacks have been rare since.

    I would add ambien to the list. As would my eye doc.

    Some 20 years ago I began to experience mild, but annoying, dry eye. An ophthalmologist suggested drugstore artificial tears. I bought some, but before trying them even once, I reflected that this solution was going to become very tiresome if, as he indicated, I would need to use them for the rest of my life.
    Somewhere, I no longer remember just how, I learned that evening primrose oil could help dry eye. I tried borage oil, which contains the same essential ingredient (gamma linolenic acid) but is much cheaper. The dry eye essentially went away. A time or two since then, I have tried cutting back on the borage oil (I take three grams a day orally), but each time the dry eye returned.
    In the last year or two, a bit of the dry eye seems to be coming back. Even if it does, twenty years of success seems pretty good. Three grams of the borage oil is a hefty dose, and I don’t intend to try increasing it.

    Apx. March of last year, I started having a major problem with dry eyes. I used a variety of artificial tears as well as regular eye drops but got only brief relief with any of them and I was using them frequently during the day. I remembered something from People’s Pharmacy re. castor oil. After a bit of research I went to a health food store and bought cold pressed, hexane free castor oil. I have been using it for several months and have never needed it more than twice in one day. All it takes is a drop or two. Oh what sweet relief.

    My dry eyes drove me crazy- tried all the things the opthalmologist suggested none of which worked. The itch was unbearable, I felt like clawing my eyes out at times, especially the tear ducts.
    Finally I decided to try an anti-fungal ointment on my eyelids, and voila, relief. It took awhile of daily application but it worked.
    I checked with my pharmacist & she said as long as I didn’t put it into the eye it should be no problem. I use plain saline eye drops without all the extra ingredients in today’s drops because they are very irritating in themselves. I keep a bottle in my purse & at the bedside so I never have to put up with the dryness that I still have.
    This regimen has maintained the integrity of my corneas too.The expensive eyelid cleaning wipes can be replaced by using a cotton ball & contact lens wetting solution.

    I am a Sjogren’s patient and have found that the eye drops and tears that are individually packaged by dose work much better than the ones with preservatives in them. The ones with preservatives actually worsen my symptoms.
    I know I am allergic to benzalkonium chloride and thimerosal and many other people are without being aware of it. Watch out as the thimerosal is also in some vaccines so I am always careful to ask after very uncomfortable reactions in the past. Fish oil also helps and don’t run a fan at night or allow AC or heater to blow directly at you in the car.

    Fifteen years ago, I had several spells of “recurrent erosion” (I would awaken with my eyelid stuck to my cornea – very painful!) and it was finally suggested that I use Bausch & Lomb’s Muro 128 (5%) ointment. I’ve used that every night at bedtime ever since and have not had another episode. For occasional dryness in the daytime, I use Muro 128 drops (ointment in the daytime makes vision too blurry). I take several drugs that cause dryness, so the Muro is a godsend.

    Sometimes I have the feeling that I get a dry patch behind my eye when I sleep. This can be painful in the morning and I put in eye drops and massage my eye to relieve the pain. Maybe I sleep with my eye open to cause this. Anyone else?

    Every morning I wake up with that dry patch. My eyes feel uncomfortable from dry eyes, so I use a good eye drop brand every 1-2 hours as needed during the day. Before bed, I put 2-3 eye drops in each eye and keep closed for 30 seconds. When I wake up, or the alarm goes off, I have trained myself to just gently hold the eyes shut with my fingers, and then slowly open my eyes. It keeps the eye ball from being scratched. I immediately place 2 eye drops in my eyes. You kinda get used to it.

    I use fish oil capsules for my dry eyes: 3 capsules per day, one at each meal.
    Also, in the past, I used Chinese herbs (traditional Chinese medicine) that included mulberry leaf and got relief that way.

    I have had moderate to mild dry eye for years. One opthalmologist I used to go to strongly recommended lubricating eye ointment. I used it and soon after my eyes were red swollen and unbearably itchy.
    Beleive it or not it took me a long time to figure out it was the eye ointment causing the problem. Then it took a long time to get the reaction to quiet down.
    Pred-forte eye drops worked, but as soon as I tapered off enough the horrible itchyness returned.
    Fnally I went to a dermatologist who prescribed a doxycycline at low dose, and amazingly that is what worked. I have never used any eye medication since then, and hope I never have to as the symptoms were unbearable.
    I have been on fish oil capsules for years and the dry eye is improved and not usually bothersome. I find that driving, especially with the air conditioning blowing toward my face really dries my eyes out, as does a fan. I sometimes use a sleep mask at night if the celing fan is on.

    I have terrible chronic dry eyes. This is from a combination of having Hypohydrotic Ectodermal Dysplasia, menopause, a history of receiving chemotherapy, allergies, and who knows what else. Even with using preservative free eye lubricants many times a day and Restasis twice a day for years as well as taking Dry Eye Omega with D3 twice a day, my condition is not good. I also have plugs in my tear ducts. A few months ago my Ophthalmologist had to remove an area of one cornea that was “wrinkling” and separating from the next layer. I never even knew such a thing could happen. I really fear that my vision will be affected by this condition at some point.

    * Be nice, and don't over share. View comment policy^