meds that DON'T cause dry eye

[littlemermaid]

Contraindications, preexisting conditions, side effects

As spmcc says, just as an example, even on something as innocuous as vitamin A, we'd be keeping ourselves well informed.

Ophthalmic Physiol Opt. 2005 May;25(3):179-94.
Possible contraindications and adverse reactions associated with the use of ocular nutritional supplements. Bartlett H, Eperjesi F. Source: Neurosciences Research Institute, Aston University, Birmingham, UK.

Abstract
The role of oxidation in the development of age-related eye disease has prompted interest in the use of nutritional supplementation for prevention of onset and progression. Our aim is to highlight possible contraindications and adverse reactions of isolated or high dose ocular nutritional supplements. Web of Science and PubMed database searches were carried out, followed by a manual search of the bibliographies of retrieved articles. Vitamin A should be avoided in women who may become pregnant, in those with liver disease, and in people who drink heavily. Relationships have been found between vitamin A and reduced bone mineral density, and beta-carotene and increased risk of lung cancer in smoking males. Vitamin E and Ginkgo biloba have anticoagulant and anti-platelet effects respectively, and high doses are contraindicated in those being treated for vascular disorders. Those patients with contraindications or who are considered at risk of adverse reactions should be advised to seek specialist dietary advice via their medical practitioner.

(With hypersensitivities, LM has had very rare systemic responses to steroid and antibiotics. AI patients are all too aware of this.)

[Scout]

In reality clincians like myself do not notice such correlations, Im sure it has happened, but does that make it significant?

It would be significant if your patient was experiencing that side effect.

Now, does that mean we should all stop using vitamin A? As I said, if you took all these "side effects" literally and without thought, you would not use any medications ever

I can understand why you might be concerned, but in reality, there is not much to worry about, for example, when its hayfever season and many people start oral anti histamines, we have never seen a surge of dry eye patients.

I would hope that physicians would listen to a patient who experiences side effects and suggest an alternative medication with fewer side effects. If there is no alternative medication, I would hope that physician listens and responds to the patient’s concerns and helps them alleviate the side effects, as rare as they may be.

Please consider that patients with a history of dry eye, ocular surface disease, ocular inflammation, underlying autoimmune disorders and other medical diagnoses that cause dry eyes and ocular inflammation may need to be treated differently by medical professionals than the typical healthy patient.

Most (if not all) drug studies are done using normal healthy patients. So the fact that a particular oral or topical medication does not produce ocular dryness in a normal healthy patient cannot be applied equally to patients with ocular surface disease or inflammation.

Alcohol applied to normal skin will not produce pain. However, alcohol applied to skin that is inflamed from a burn will often produce pain and extreme discomfort. The medication doesn’t cause burning and discomfort per se (so we won’t all stop using alcohol) but I wouldn't rub it on my skin if I had a serious burn.

Thank you, Ahmed, for interacting with this forum. We appreciate the input. I hope we can learn from each other.

Scout

[littlemermaid]

Ahmed, Are you a prescribing optometrist?

[spmcc]

Let me give you an example of what I mean, if I turn to the page of the BNF regarding vitamin A, I will list what it says:

fatigue, irritability, mental changes, anorexia, stomach discomfort, nausea, vomiting, mild fever, excessive sweating, increased risk of osteoporosis and hip fracture, liver disease, BIRTH DEFECTS.

Now, does that mean we should all stop using vitamin A? As I said, if you took all these "side effects" literally and without thought, you would not use any medications ever.

I don't understand your example. I think perhaps the BNF is not clear or specific enough to be useful. Isotretinoin (a retinoid derived from vitamin A) is NOT safe for use during pregnancy because it causes birth defects. That shouldn't be taken lightly.

I am not a fear-monger. I am not anti-Western medicine or anti-pharmaceuticals. In fact, I'm the opposite. I believe in evidence-based medicine. Evidence (from clinicians involved in strictly-designed clinical trials and research) has shown that drugs have REAL, unintended, and undesirable side effects. These side effects are often worse in certain populations.

I am not suggesting that people with dry eyes stop taking their meds. What I am suggesting is that people be informed about which types of drugs can cause/worsen dryness because side effects are real and not fabrications by drug companies.

[Hopeful2]

Ahmed, thank you for putting the medication side effect risk issue into perspective. For those of us suffering from dry eye, I think we are sensitive to the potential for an aggravation of the 'dry eye'. With dry eye, it can be difficult to monitor treatment. We wouldn't want to compound this difficulty by adding yet another medication to our mix that could be adding to our dry eye symptoms.

One always needs to weigh the benefits against the potential risks. When it comes to treating dry eye and another illness, this is not always easy to do. I think this is why many of us are looking to nutrition, herbal, homeopathic, lifestyle and environmental solutions when looking to address our health concerns.

[Ahmed]

Thanks for the long list, but I think you misunderstood where Im coming from.

In reality clincians like myself do not notice such correlations, Im sure it has happened, but does that make it significant?

Let me give you an example of what I mean, if I turn to the page of the BNF regarding vitamin A, I will list what it says:

fatigue, irritability, mental changes, anorexia, stomach discomfort, nausea, vomiting, mild fever, excessive sweating, increased risk of osteoporosis and hip fracture, liver disease, BIRTH DEFECTS.

Now, does that mean we should all stop using vitamin A? As I said, if you took all these "side effects" literally and without thought, you would not use any medications ever.

I can understand why you might be concerned, but in reality, there is not much to worry about, for example, when its hayfever season and many people start oral anti histamines, we have never seen a surge of dry eye patients.

[spmcc]

It is common knowledge that certain medications decrease tear production.

From wikipedia (http://en.wikipedia.org/wiki/Keratoc...ivitis_sicca):

Drugs such as isotretinoin, sedatives, diuretics, tricyclic antidepressants, antihypertensives, oral contraceptives, antihistamines, nasal decongestants, beta-blockers, phenothiazines, atropine, and pain relieving opiates such as morphine can cause or worsen [dry eye] condition.

From the Mayo Clinic http://www.mayoclinic.com/health/dry...SECTION=causes :

Medications that can cause dry eyes include:
Certain types of drugs used to treat high blood pressure, such as central-acting agents and diuretics
Antihistamines and decongestants
Birth control pills
Certain antidepressants
Pain relievers, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve)
Isotretinoin-type drugs for treatment of acne

From http://www.agingeye.net/mainnews/dryeye.php :

Dry eye also can be caused by certain medications, including antihistamines, some antidepressants, birth control pills, nasal decongestants, and the prescription acne drug Accutane.

University of Michigan http://www.kellogg.umich.edu/patient.../dry.eye.html:

A wide variety of common medications that can cause dry eye include diuretics; betablockers; antihistamines; sleeping pills; medications for "nerves"; pain relievers; or alcohol.

http://www.eyecaresource.com/conditi...dications.html

Here's a look at some of the different medications that have been reported to cause dry eyes:

•Antihistamines
•Antidepressants
•Sleeping Pills - Over-the-counter sleep aids, as well as prescription sleep aids will cause these side effects.
•Birth Control Pills
•Diuretics
•ACE Inhibitors
•Isotretinoin-Type Drugs
•Opiates

Some peer-reviewed journal references from pubmed:

http://www.ncbi.nlm.nih.gov/pubmed/21684522 - 2011... antidepressants and anti-anxiety medications

http://www.ncbi.nlm.nih.gov/pubmed/17617284 - 2007... oral antihistamine

http://www.ncbi.nlm.nih.gov/pubmed/16565363 - 2006... OTC pain meds

http://www.ncbi.nlm.nih.gov/pubmed/15083682 - 2003... antidepressants, betablockers, diuretics, oral contraceptives

http://www.ncbi.nlm.nih.gov/pubmed/3898476 - 1985... beta-blocker and atropine

http://www.ncbi.nlm.nih.gov/pubmed/3985085 - 1985... diuretic

http://www.ncbi.nlm.nih.gov/pubmed/429237 - From 1979... atropine in the animal model (dogs), but you can also find papers on cats and horses.

[Ahmed]

I don't believe that drug companies casually add side effects to their drug profiles just to cover their a$$es. This will make the drugs appear less appealing. They will *only* list side effects reported by test subjects.

However, whether a person is affected by a certain side effect is an individual thing.


There are a number of types of common medications, both prescription and over-the-counter, that can cause (or worsen) dry eyes. They include:

* antihypertensives
* diuretics
* angiotensin-converting enzyme (ACE) inhibitors
* antihistamines and decongestants
* sleeping pills
* birth control pills
* antidepressants
* isotretinoin-type drugs (e.g., Accutane)
* opiate-based pain relievers

Due to our increased sensitivity to drying effects, any medicine (Rx or OTC) that lists "dry mouth" and/or "constipation" as a side effect should warrant caution.

If you look at the side effects listed in the books, you will see what I mean, if you took them all seriously, you would never use any medications. Also like I said, in reality its only really roaccutane thats strongly linked to dryness, Im not aware of any others that I have found have actually caused/increased dryness. Im happy to be corrected, but from my experience, what I have said is true.

[Schatten]

Informative link to prescription drugs and effect on eyes.

http://www.naturaleyecare.com/FAQ/qu...-harm-eyes.asp

Antibiotics, when prescribed topically for eye problems side effects may include allergic conjunctivitis (red eye). Systemic antibiotics taken orally, intramuscularly, or intravenously to fight bacterial infections may cause some visual symptoms. For example: 1. Synthetic penicillins (amoxicillin and ampicillin) can cause some mild redness of the eyes, itching, and dry eyes.

Reading this makes me really reluctant to be taking oral antibiotics. . . any thoughts?

Well not as long as they are prescribed with responsibility and not for every small cold. A good doctor will prescribe them only if you really need them. And then you should take'em.

[Hopeful2]

Informative link to prescription drugs and effect on eyes.

http://www.naturaleyecare.com/FAQ/qu...-harm-eyes.asp

Antibiotics, when prescribed topically for eye problems side effects may include allergic conjunctivitis (red eye). Systemic antibiotics taken orally, intramuscularly, or intravenously to fight bacterial infections may cause some visual symptoms. For example: 1. Synthetic penicillins (amoxicillin and ampicillin) can cause some mild redness of the eyes, itching, and dry eyes.

Reading this makes me really reluctant to be taking oral antibiotics. . . any thoughts?

[spmcc]

I don't believe that drug companies casually add side effects to their drug profiles just to cover their a$$es. This will make the drugs appear less appealing. They will *only* list side effects reported by test subjects.

However, whether a person is affected by a certain side effect is an individual thing.


There are a number of types of common medications, both prescription and over-the-counter, that can cause (or worsen) dry eyes. They include:

* antihypertensives
* diuretics
* angiotensin-converting enzyme (ACE) inhibitors
* antihistamines and decongestants
* sleeping pills
* birth control pills
* antidepressants
* isotretinoin-type drugs (e.g., Accutane)
* opiate-based pain relievers

Due to our increased sensitivity to drying effects, any medicine (Rx or OTC) that lists "dry mouth" and/or "constipation" as a side effect should warrant caution.

[littlemermaid]

http://www.dryeyezone.com/talk/showt...ght=#post65115

[littlemermaid]

http://www.dryeyezone.com/talk/showt...ght=#post65115
Just in case anyone hasn't seen it, this is a truly awesome post on this topic and kindly lists online formularies and access to US FDA drug reaction reports.

[Ahmed]

There are several manuals, theres Minims, BNF etc.

However be advised, just because they may say "this can cause x, y, and z," it may not do, and the drug manufactures really try to cover themselves, so they list every possible scenerio, which is not that helpful to anyone.

The only medications that really cause dryness are roaccutane (for acne) , rarely thyroxine, anti histamines seem to have a mild effect. Other than that I think the chance of getting increased dryness from other meds is very very low.

[spmcc]

If only consumers had access to this pharmacist manual hopeful2.

It's called the PDR (Physicians' Desk Reference). It's in every doctor's exam room that I've ever been in the US and Canada. It may also be at your public library. Altho keep in mind that it's updated yearly so the library may have an old copy.

I think it would be very easy to go to a doctor's office and ask to look at a copy. I'd do it, no problem.