Dry Eye Clinic
Dr. Abdalrahman Alabsi
Is your medication causing your dry eye?
By Dr. Abdalrahman Alabsi – Ophthalmologist | Last reviewed: October 2026
Dry eye disease caused by medications and by medical and cosmetic procedures
The ocular surface and tear film are the most affected by topical eye drops and treatments, and they are also affected by eye surgery.
Treatment of medication-related dry eye aims to identify the responsible medication and stop or replace it when it is safe to do so after consulting the treating physician, or to switch to preservative-free drops.
Some treatment may be essential to prevent vision loss, as with glaucoma drops. However, reducing the total number of preserved eye drops and replacing them with preservative-free drops, or considering alternatives such as laser treatment for glaucoma, can significantly reduce cumulative toxicity to the ocular surface while keeping the disease under control.
Topical medications that lower eye pressure (glaucoma drops) and their effect on dry eye:
In one study, more than 40% of patients using pressure-lowering drops for glaucoma had dry eye symptoms, as glaucoma treatment is usually daily and lifelong.
The most common dry eye symptoms in patients using glaucoma drops:
Pain when instilling eye drops, foreign body sensation (a sandy feeling in the eye), and burning, with more than 20% showing signs of blepharitis, conjunctival hyperemia, or keratitis.
Studies show that these findings become steadily more common with the use of preserved drops.
The most common dry eye signs in patients using glaucoma drops:
Signs of dry eye appeared in more than half of patients, with abnormal Schirmer test results (which measure the aqueous tear layer) in 61%, reduced tear break-up time in 78%, and ocular surface staining in 22%.
Dry eye statistics in patients using glaucoma drops:
A large study showed that dry eye prevalence was higher in women (56.9%) than in men (45.7%), and it increased further with age and with the use of three or more glaucoma medications.
Among glaucoma medications, patients using brimonidine reported the most symptoms, while timolol was associated with light-evoked pain (photosensitivity) and latanoprost with a burning sensation.
The role of preservatives in dry eye disease:
Benzalkonium chloride is one of the most common preservatives in eye drops and has well-documented toxicity to the ocular surface. It is a quaternary ammonium preservative.
Concentrations as low as 0.0001% can damage corneal epithelial cells.
Its effects include mitochondrial dysfunction, oxidative stress, activation of inflammation on the ocular surface, DNA damage, and reduced corneal nerve fiber density.
Systemic medications (such as oral pills) and dry eye:
Many systemic medications are associated with an increased risk of dry eye disease.
Antihistamines and systemic corticosteroids have been associated with severe dry eye symptoms.
The effect of isotretinoin (known as Roaccutane) on dry eye:
Roaccutane is used to treat acne. It causes atrophy of the oil glands and ductal keratinization in the tear-secreting oil glands (meibomian glands) through a pro-apoptotic mechanism. This leads to severe dry eye symptoms, reduced tear break-up time, faster tear evaporation, and lower Schirmer test values (which measure the aqueous layer), with some cases persisting long after the drug is stopped.
The effect of antidepressants on dry eye:
Depression itself and the use of antidepressants each independently and significantly increase dry eye disease, owing to multiple anticholinergic effects and disruption of the corneal epithelial barrier.
Hormone replacement therapy after menopause and dry eye:
Hormone replacement therapy increases dry eye, and it occurs more often with higher doses and longer treatment duration.
Contact lenses and dry eye:
Contact lens wear is an established cause of dry eye disease.
Contact lenses cause dry eye disease by thinning the tear film, increasing friction on the ocular surface, and disrupting normal blinking.
Cosmetic procedures and dry eye:
If complications occur, Botox injections around the eyes can cause incomplete eyelid closure (lagophthalmos), which exposes the ocular surface and increases evaporative water loss.
Treatment-induced dry eye is common and, in many cases, modifiable. Patients should therefore tell their doctor about all the medications they use, including topical eye drops, and mention any recent cosmetic eyelid procedures, because identifying a reversible, medication-related cause can appropriately change the treatment plan.
References
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2. Gomes JAP, Azar DT, Baudouin C, et al. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf. 2023;29:331-385. doi:10.1016/j.jtos.2023.04.011
3. Leung EW, Medeiros FA, Weinreb RN. Prevalence of ocular surface disease in glaucoma patients. J Glaucoma. 2008;17(5):350-5. doi:10.1097/IJG.0b013e31815c5f4f
4. Baudouin C, Labbé A, Liang H, et al. Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res. 2010;29(4):312-34. doi:10.1016/j.preteyeres.2010.03.001
5. Jones L, Efron N, Bandamwar K, et al. TFOS Lifestyle: Impact of contact lenses on the ocular surface. Ocul Surf. 2023;29:175-219. doi:10.1016/j.jtos.2023.04.010