How medications affect the tear film

Medications can disrupt the tear film through several mechanisms — reducing aqueous tear production, altering meibomian gland secretion, affecting goblet cell function, or promoting ocular surface inflammation. Most do so as a side effect rather than a primary action, which means it's often not mentioned prominently in patient information.

Medication categories associated with dry eye

Antihistamines Both oral and topical antihistamines have significant anticholinergic effects — reducing secretion across multiple glands including the lacrimal gland. Dry eyes and dry mouth are among the most common side effects of antihistamine use. This applies to both older sedating antihistamines and newer non-sedating formulations, though the effect is generally less pronounced with newer agents.

Antidepressants Tricyclic antidepressants and SSRIs are both associated with reduced tear production. Tricyclics have pronounced anticholinergic effects. SSRIs affect tear production through less well understood mechanisms but the association is clinically significant.

Beta-blockers Both oral and topical (eye drop) beta-blockers reduce tear production. Topical beta-blockers used for glaucoma management are a particularly relevant cause of dry eye in older patients — the systemic absorption from eye drops is significant despite the local route of administration.

Diuretics By promoting fluid excretion, diuretics can reduce the aqueous component of the tear film and worsen dry eye symptoms — particularly in patients who are also inadequately hydrated.

Hormone-related medications The oral contraceptive pill, HRT, anti-androgen medications, and medications affecting hormone balance can all influence tear film stability through their effects on lacrimal and meibomian gland function.

Isotretinoin (Roaccutane) Isotretinoin — used for severe acne — has a pronounced effect on meibomian gland function. It reduces gland secretion significantly, causing or worsening evaporative dry eye. The effect can persist after the medication is stopped, and in some patients causes permanent meibomian gland changes.

Chemotherapy agents Several chemotherapy drugs affect the ocular surface through various mechanisms — reducing tear production, causing conjunctival inflammation, or directly damaging ocular surface tissues.

Antipsychotics Several antipsychotic medications have anticholinergic properties that reduce tear production.

Decongestants Oral decongestants — including pseudoephedrine — have drying effects on mucous membranes including the ocular surface.

Dupilumab A dedicated page covers dupilumab-associated ocular surface disease in detail — see Dupilumab Ocular Surface Disease.

What to do if you suspect a medication is causing dry eye

Don't stop medication without medical advice. Many of the medications listed above are prescribed for important conditions, and stopping them without medical supervision can be harmful.

What you should do is:

• Note when your dry eye symptoms started relative to when you began the medication
• Discuss the connection with your prescribing GP or specialist — there may be alternative medications with less ocular surface impact
• Seek a dry eye assessment so the ocular surface consequences can be properly evaluated and managed

In many cases, appropriate dry eye treatment can effectively manage the ocular surface consequences of a medication that is otherwise essential for your health.

At your assessment

Please bring a complete list of your current medications — including over-the-counter products and supplements. Medication history is an important part of our dry eye assessment and helps us understand what may be driving your symptoms.

📍 Openshaw Opticians, Unit 4, 16 Cheapside, Cleckheaton, BD19 5AF 

📞 01274 878214