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Dry eye: sometimes drug-induced

The daily lives of many patients are affected by discomfort and visual disturbances, or even ocular lesions, associated with dry eye syndrome. Drugs are sometimes to blame.

Dry eye is a common condition, especially in the elderly and in women. It presents with non-specific ocular signs and symptoms (burning sensations, redness, a “gritty” feeling in the eyes, sensitivity to light etc.). In severe cases, lesions affecting the surface of the eye and visual disturbances are possible, with a risk of blindness.

This condition is linked to a reduction in the quality and quantity of the tear film, and is characterised by inflammation and lesions affecting the ocular surface, notably the cornea. These lesions themselves then become factors disrupting the tear film. A range of factors can be to blame, including physiological predisposition, autoimmune disease, diabetes, Parkinson's disease, and a dry-air environment.

Various drugs can cause dry eye. These include drugs administered by the ocular route (e.g. glaucoma treatments, non-steroidal anti-inflammatory drugs, H1 antihistamines), or by the intravitreal route, but also those given orally or by injection (e.g. atropine-like drugs used to treat urinary incontinence, allergies or depression, as well as beta-blockers, diuretics etc.). The risk is also increased by many eye drop preparations and the presence of preservatives in some ophthalmic medicinal products.

The deleterious effects of drugs on the tear film should be taken into account in contact lens wearers.

Drug-induced dry eye is often reversible on stopping the drug, which should be tried in order to avoid severe damage and scarring. Other options include dose reduction, a change of treatment, or symptomatic treatment of the dry eye condition.

©Prescrire 1 March 2021

Source: "Drug­-induced dry eye " Prescrire International 2021; 30 (224): 72. Subscribers only.

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See also:

"Dry eye: sometimes
associated with
antimuscarinic drugs"
(May 2020)
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"Drug-induced corneal
damage"
(April 2014)
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