Medications That Cause Dry Eye
Dozens of commonly prescribed medications can cause or worsen dry eye disease — and most patients never connect the dots between a new prescription and the eye symptoms that followed. According to the TFOS DEWS II Iatrogenic Report, medication-induced dry eye is one of the most overlooked drivers of chronic ocular surface disease. This page covers the most common medication classes that cause dry eye, the mechanism for each, and what to discuss with your physician if your medications may be contributing to your symptoms.
Which Drugs Cause Dry Eyes? Quick Reference
The medicines most likely to cause or worsen dry eyes work by reducing tear production, changing tear chemistry, or affecting the oil glands in the eyelids. The drug classes that most commonly cause dry eyes include:
- Antihistamines — allergy medicines like diphenhydramine, loratadine, and cetirizine
- Antidepressants — SSRIs, SNRIs, and tricyclics
- Blood pressure medications — beta-blockers (oral and glaucoma drops) and diuretics
- Antimuscarinics for overactive bladder — oxybutynin, tolterodine, solifenacin
- Decongestants — pseudoephedrine and phenylephrine
- Isotretinoin (Accutane) and some retinoids
- Hormone therapy — contraceptives and hormone replacement
- Antipsychotics — especially first-generation agents
- Chemotherapy drugs — including 5-fluorouracil and cytarabine
Below, we explain how each of these medicines causes dry eye and what you can do about it — without stopping any prescription on your own.
If your dry eye started or worsened after beginning a new medication, that timing is almost certainly meaningful. Many patients are told their dry eye is age-related or unexplained when in fact a routine medication is a primary contributor. Recognizing the medication connection often opens up treatment options that would otherwise be missed.
An important note before we go further: never stop or change any prescription medication based on information from a website. This page is informational. If you suspect a medication is contributing to your dry eye, the right next step is a conversation with your prescribing physician and a comprehensive dry eye evaluation — not unilateral changes to your medication regimen.
How Medications Cause Dry Eye
Medications cause dry eye through several distinct mechanisms, often more than one at a time for any given drug:
- Reduced aqueous tear production — anticholinergic effects reduce the watery component of tears
- Altered tear composition — some medications reach the tear film and change its chemistry
- Reduced blink rate — sedating medications and those affecting alertness reduce protective blinking
- Direct toxicity — some medications damage the corneal or conjunctival epithelium
- Meibomian gland dysfunction — certain drugs (particularly isotretinoin) directly affect oil-producing glands
- Hormonal disruption — affects multiple aspects of tear production and quality
Medication Classes That Commonly Cause Dry Eye
Antihistamines
Antihistamines used for allergies (Benadryl/diphenhydramine, Claritin/loratadine, Zyrtec/cetirizine, Allegra/fexofenadine) all have anticholinergic properties that reduce tear production. The older, sedating antihistamines (diphenhydramine) are the strongest offenders. Newer, non-sedating antihistamines are less drying but still measurable.
This is particularly problematic for patients who use chronic seasonal allergy treatment — months of daily antihistamine use can significantly reduce tear production.
Antidepressants
SSRIs (sertraline/Zoloft, fluoxetine/Prozac, citalopram/Celexa, escitalopram/Lexapro) commonly cause dry eye through serotonergic effects on the lacrimal gland and altered blink behavior.
Tricyclic antidepressants (amitriptyline/Elavil, nortriptyline/Pamelor) have stronger anticholinergic effects and cause more severe dry eye than SSRIs.
SNRIs (venlafaxine/Effexor, duloxetine/Cymbalta) cause moderate dry eye through both serotonergic and noradrenergic mechanisms.
Blood Pressure Medications
Beta-blockers (atenolol, metoprolol, propranolol) — both oral and topical (the eye drops used for glaucoma) — reduce tear production. This is a common source of dry eye in glaucoma patients, where the very drops protecting their vision may also be drying their ocular surface.
Diuretics (hydrochlorothiazide/HCTZ, furosemide/Lasix) reduce systemic fluid volume, which secondarily reduces tear production.
Clonidine and similar central-acting agents can also reduce tear production.
Hormone Therapy
Hormonal contraceptives, hormone replacement therapy, and androgen-deficiency-related treatments all affect tear production. Estrogen-only hormone replacement is associated with worse dry eye than combined estrogen-progesterone therapy in some studies.
This intersects with menopause-related dry eye in complex ways — see also our menopause and dry eye page.
Isotretinoin (Accutane)
Isotretinoin used for severe acne directly suppresses Meibomian gland function. The dry eye effect typically resolves after the course is complete, but in some patients, gland dysfunction persists for years or permanently. Anyone considering isotretinoin should be aware of this risk, and patients currently on isotretinoin should be monitored.
Antipsychotics
First-generation (typical) antipsychotics (haloperidol, chlorpromazine) have strong anticholinergic effects. Second-generation (atypical) antipsychotics (olanzapine, quetiapine, risperidone) vary in their anticholinergic activity but most cause some degree of dry eye.
Antimuscarinics
Medications used for overactive bladder (oxybutynin, tolterodine, solifenacin) directly block the cholinergic signaling that drives tear production. These are among the most strongly drying medications.
Decongestants
Pseudoephedrine, phenylephrine, and similar decongestants — used for nasal congestion and in many cold medications — reduce tear production through vasoconstrictor effects on the lacrimal gland.
Chemotherapy Agents
Several chemotherapy agents cause ocular surface toxicity and severe dry eye, including 5-fluorouracil, cytarabine, busulfan, and many targeted therapies. Patients undergoing chemotherapy who develop eye symptoms should be evaluated promptly.
Other Notable Medications
- Acne treatments beyond isotretinoin (some topical retinoids)
- Bisphosphonates for osteoporosis
- Cannabis/CBD products affect tear production in some users
- Preservatives in eye drops — chronic use of preserved drops can paradoxically worsen dry eye
What to Do If You Suspect a Medication Is Contributing
Step 1: Get a Proper Evaluation
A comprehensive dry eye evaluation can identify the pattern of damage consistent with medication-induced dry eye versus other causes. Dr. Kresch reviews your full medication list as part of the evaluation.
Step 2: Talk to Your Prescribing Physician
If a medication is identified as a likely contributor, the conversation with your prescriber should cover: whether the medication is still necessary, whether dosage can be reduced, whether alternative medications with less anticholinergic activity are available, and whether timing changes (taking medications later in the day, for example) might help.
Do not stop or change medications without coordinating with your prescriber. Many of these medications have significant withdrawal effects or treat conditions with their own risks if untreated.
Step 3: Treat the Dry Eye Directly
Whether or not medication changes are possible, treating the dry eye disease itself usually produces significant improvement. Treatment may include prescription anti-inflammatory drops, in-office treatments like IPL or RF if Meibomian Gland Dysfunction is present, punctal plugs to conserve tears, and lifestyle modifications.
Step 4: Coordinate Care
For patients on complex medication regimens, the best outcomes come from coordinated care between the prescribing physician and the dry eye specialist. Dr. Kresch routinely communicates with referring physicians to align treatment decisions.
Frequently Asked Questions
Q: Should I stop taking my medication if I think it is causing my dry eye? Absolutely not. Never stop a prescription medication based on a website. Talk to your prescribing physician about any concerns. Many medications treat serious conditions where stopping could cause significant problems.
Q: How do I know if my medication is causing my dry eye? The timing is the strongest clue — symptoms that started or worsened soon after beginning a new medication suggest a connection. A comprehensive dry eye evaluation can also identify patterns consistent with medication-induced dry eye.
Q: Will my dry eye go away if I stop the medication? Sometimes, but not always. Some medication-induced dry eye is reversible after stopping the drug; some causes lasting changes (particularly isotretinoin and chronic anticholinergic exposure). Either way, treating the existing dry eye disease usually helps.
Q: I take many of the medications on this list. What does that mean? Patients on multiple drying medications are at very high risk for chronic dry eye. The combined anticholinergic burden often produces more severe dry eye than any single medication would. Coordinated medication review with your physician is particularly valuable for these patients.
Q: Can I just use more artificial tears to compensate? Tears help symptomatically but do not address the underlying problem. Heavy artificial tear use can also paradoxically worsen dry eye if the drops contain preservatives. Most patients benefit from a proper evaluation and a structured treatment plan.
Q: Are eye drops also a problem? Some are. Preserved artificial tears used heavily for years can damage the ocular surface. Glaucoma drops, particularly beta-blockers, cause significant dry eye in many patients. Preservative-free formulations are preferred for chronic use.
Q: My doctor said my dry eye is just from aging. Could medications be the real cause? Possibly. Aging contributes to dry eye, but medications are often a parallel or even primary cause that gets attributed to age. A proper diagnostic workup can distinguish the two.