Medications causing dry eye

[littlemermaid]

http://www.hindawi.com/journals/jop/2012/285851/

'The Role of Medications in Causing Dry Eye', Frederick T. Fraunfelder, James J. Sciubba, and William D. Mathers Volume 2012 (2012), Article ID 285851

'The role of medications in causing or aggravating DED is complex and this paper suffers from oversimplification and incomplete data []. Nonetheless, sufficient information is available to make the following recommendations to clinicians.

(1) The role of systemic and topical ocular medications in causing dry eye is probably underappreciated. There is a need to determine if the drying effects of systemic and topical ocular medications are additive or synergistic.

(2) Oral polypharmacy needs to be studied as a cause of dry eye. The total number of drugs should include not only prescription drugs, but topical ocular medications,
over-the-counter medications, and herbals as well.

(3) Clinicians should remember that if a medication causes a dry mouth, it may also cause or aggravate dry eye.

(4) It is probable that the duration of topical ocular therapy is relevant as a cause of dry eye. Topical BAK may be the primary factor in causing DED and ocular surface disease in a given patient.

(5) It is important to question the diagnosis of primary Sj¨ogren’s Syndrome without adequate laboratory confirmation if the patient has a history of polypharmacy or if onset of dry eye or mouth occurred within 3 months of a change in medication.

(6) Available on the National Registry of Drug-Induced Ocular Side Effects website, http://www.eyedrugregistry.com/, are
(a) bibliography of a drug’s side effect profile listed in Tables 3 and 4;
(b) list of drugs causing dry mouth;
(c) causes of polypharmacy.'

[Scout]

Great find, littlemermaid! And the article is published with free full text access. Wonderful.

Dr. Fraunfelder (Casey Eye Institute at Oregon Health and Science University in Portland) has been researching and publishing studies on the ocular side effects of medications for many years. But his main area of study has been on the systemic medications. I have been hoping that he would start focusing on the topical medications.

I am very encouraged that he is using phrases such as “polypharmacy” as it applies to ophthalmic medications. More medications does not always mean better treatment. It can mean more side effects.

And haven’t we heard this mentioned here (to each other) on the forums like, oh, maybe hundreds of times?

The pharmacological, physiological, anatomical, and histological mechanisms causing dry mouth differ little from those causing dry eye.

Why drug studies do not typically list “dry eye” but do list “dry mouth” makes no sense, since they are essentially the same thing. There is a whole lovely paragraph in this article that explains biologically why that is.

Topical ocular polypharmacy has been shown to cause DED.

Topical polypharmacy is apparently a very popular treatment plan these days. Call it a “routine” or a “regimen” but it is polypharmacy, and it is not always helpful in the long run.

This was a very interesting paragraph:

Since so many classes of drugs cause both a dry mouth and dry eye (Table 1) and since polypharmacy is the number one cause of dry mouth and possibly important in dry eye, the effects of polypharmacy must be ruled out before diagnosing primary Sjögren’s syndrome. In a dry eye and mouth study which showed that the addition of each class of drugs increased the prevalence of dry eye or dry mouth, the authors also found that if a female took 7 prescription drugs with known sicca effects on the mouth or eyes, there was also an increased prevalence of vaginal dryness [8].
In evaluating patients for primary Sjögren’s syndrome, a history of polypharmacy and recent drug use must be sought. Any changes in medication, especially during the previous 3 months, should be considered as potentially causing or worsening dry mouth or dry eye. Labeling a patient as having primary Sjögren’s without unequivocal serologic and tissue studies (minor salivary gland biopsy) may add significant emotional stress resulting from the perceived implications of an autoimmune disease diagnosis.

[spmcc]

OMG... what a great find, LM! I've found that any drug that lists dry mouth or constipation as a side effect means worse dry eye for me... sometimes 3-4 days of increased dryness from one silly OTC pill!! It's wonderful to see this written so well in published research. I hope it catches on with MDs.

[eye_allergy-kids]

. Nonetheless, sufficient information is available to make the following recommendations to clinicians.

Well done LM You have found, these doctors and the drug companies all play the game not the cure for patient. They do not know what they are doing we do not know what to do. Money is spent and earned. Our eyes are gone for six.

These researchers also the same but this looks different...?

[Blinks]

LM, I just PM-ed you. Thank you for this excellent article. Extremely helpful and powerful information there.

Eye_allergy-kids, I echo your comments on the drug company game.

Blinks

[Blinks]

I visited the eyedrugregistry.com site and found this text cited:
Clinical Ocular Toxicology - Drugs, Chemicals and Herbs

Copyright © 2008 Elsevier Inc. All rights reserved

Edited by:
Frederick T. Fraunfelder, MD, Frederick W. Fraunfelder, MD, and Wiley A. Chambers, MD

ISBN: 978-1-4160-4673-8

While there's no free access, abstracts of several sections are available on this site:http://www.sciencedirect.com/science/book/9781416046738

It provides toxicity information on drugs, herbs, and supplements so perhaps a useful resource. Has anyone used this to research their medications or supplements? Will try to find it through the library.

Thank you again for the article. It may be the key to open the door to many questions regarding an adverse drug reaction.

[littlemermaid]

http://www.fda.gov/Drugs/GuidanceCom.../ucm179586.htm
US FDA, 'The Public’s Stake in Adverse Event Reporting'

http://yellowcard.mhra.gov.uk/
You can report suspected side effects (also known as adverse drug reactions) to a medicine, vaccine, herbal or complementary remedy by clicking "Report Side Effect" below. The [UK] Yellow Card Scheme, run by the MHRA and the Commission on Human Medicines, is used to collect information from both health professionals and the general public on suspected side effects.

http://www.alert-project.org/ (doc only, unfortunately) 'The EU-ADR project aims to develop an innovative computerized system to detect adverse drug reactions (ADRs), supplementing spontaneous reporting systems. To achieve this objective, EU-ADR will exploit clinical data from electronic healthcare records (EHRs) of over 30 million patients from several European countries (The Netherlands, Denmark, United Kingdom, and Italy). In this project a variety of text mining, epidemiological and other computational techniques will be used to analyze the EHRs in order to detect ‘signals’ (combinations of drugs and suspected adverse events that warrant further investigation).'

http://www.hc-sc.gc.ca/dhp-mps/medef.../index-eng.php
'The Canada Vigilance Adverse Reaction Online Database contains information about suspected adverse reactions (also known as side effects) to health products.
Reports are submitted by:
•consumers and health professionals, who submit reports voluntarily
•manufacturers and distributors (also known as market authorization holders), who are required to submit reports according to the Food and Drug Regulations.'

I'm thinking that if the docs aren't too comfortable reporting problems with treatments, pharmacists can report and monitor this through their professional pathways.

[Blinks]

Thank you for posting these links. Very helpful.

The EHR discussion was especially interesting as the US is now working to implement EHRs. In the US, Kaiser Permanente and the Veterans Administration (VA) have big EHRs allowing for analysis of trends and detecting "signals" for further investigations. The VA was first to identify Vioxx as causing adverse events and it was through this large body of data and tracking out comes that it came to light so quickly. Imagine what might be accomplished with dry eye research if there was a similar patient registry or EHR research base.

http://www.alert-project.org/ (doc only, unfortunately) 'The EU-ADR project aims to develop an innovative computerized system to detect adverse drug reactions (ADRs), supplementing spontaneous reporting systems. To achieve this objective, EU-ADR will exploit clinical data from electronic healthcare records (EHRs) of over 30 million patients from several European countries (The Netherlands, Denmark, United Kingdom, and Italy). In this project a variety of text mining, epidemiological and other computational techniques will be used to analyze the EHRs in order to detect ‘signals’ (combinations of drugs and suspected adverse events that warrant further investigation).'

[sazy123]

Im glad theres some research and attention on this- because anti depressants caused my severe dry eye.

Im surprised with the amount of people out there who take antidepressants, there isnt more people whose dry eye was caused by anti depressants because the cahnge in my eyes was very significant. I had no DE symptoms (unless i wore contacts), but then damn severe dry eye set in.

[spmcc]

Antidepressants and birth control pills HUGELY increase my dryness. Whereas an antihistamine here and there doesn't (I usually only take half a pill tho).

Also naproxen (e.g., Aleve, oral NSAID) really makes my dryness worse.

It's still such a shock to discover when you take something (especially an OTC med) that the eyes tailspin into worse dryness and pain. It can take me a couple days to recover from one silly OTC pill!

[littlemermaid]

Depression, Post Traumatic Stress Disorder, and Dry Eye Syndrome ePoster no.53 AAO/APAO Chicago 2012 - Anat Galor MD; William J Feuer MS; David J Lee PhD; Victor L Perez MD

Purpose: To evaluate the relationship between psychiatric diagnoses and dry eye syndrome (DES). Methods: Patients seen in a Veterans Affairs (VA) eye clinic (2006-2011). Case-control study. Results: 2,454,458 patients were identified as a DES case (n = 462,641) or control (n = 1,991,817). Nineteen percent of males and 22% of females had a diagnosis of DES. Conditions found to increase DES risk included PTSD (OR 1.92) and depression (OR 1.92). Systemic medications found to increase DES risk included antidepressants (OR 1.97) and anxiolitics (OR 1.74). Multivariable analysis revealed that both the diagnosis and medications remained significant risk factors when considered concomitantly, although the magnitude of each association decreased. Conclusion: DES is associated with depression and PTSD and is prevalent among men and women veterans receiving eye care services.