List of All Medications that Can Worse Dry Eye

Theoretically, any medication could cause an unusual reaction and worse perceived dry eye. Published papers showing a causal relationship of dry eye caused by a particular medicine is harder to come by.

The medication that dries out the eyes most commonly (because they are the most commonly used) are in this order, in my personal experience.
1. Any drop with a preservative.
2. Antihistamines pills
3. Any medicine with anti-cholinergic properties.
4. Anti-hypertensives
5. Anti-depressants
6. Accutane

But here are other lists as well.

A patient recently told me the Avodar he used for Benign Prostatic Hypertrophy may have really started his dry eye. Medically this is possible ...or did the drug just tip his meibomian glands into "not working well enough for the new stressor in my life"?

When it comes to controlling insomnia, anxiety, depression, or suicidal ideation, it is important to treat these issue first so a patient can sleep and function normally (insomnia worsens dry eye) and then work on the dry eye issues afterwards, even though the drugs used to treat the former may worsen the dry eye. It is essential patients get the psychological help they need to function normally. 

SLC

Systemic drugs probably causing or aggravating dry eyes [13].

Class	Examples
Antihypertensive agents (beta-agonists)	Acebutolol
Antihypertensive agent (alpha-agonists)	Atenolol
Antiarrhythmic agents (beta blockers)	Carvedilol
	Labetalol Metoprolol Nadolol Pindolol Clonidine Prazosin Oxprenolol Propranolol
Antipsychotic agents	Chlorpromazine
	Fluphenazine Lithium carbonate Perphenazine Prochlorperazine Promethazine Quetiapine Thiethylperazine Thioridazine Brompheniramine Carbinoxamine Chlorphenamine (chlorpheniramine) Clemastine Cyproheptadine Dexchlorpheniramine
Bronchodilators	Diphenhydramine
Antispasmodics/ antimuscarinic	Doxylamine
Antiarrythmic agents	Ipratropium
	Atropine Homatropine Tolterodine Hyoscine (scopolamine) Hyoscine methobromide (methscopolamine) Disopyramide
Antineoplastic agents	Busulfan
	Cyclophosphamide Interferon (alpha, beta, gamma, or PEG) Vinblastine Cetuximab Erlotinib Gefitinib
Antihistamines	Cetirizine
	Desloratadine Fexofenadine Loratadine Olopatadine Tripelennamine
Antidepressants	Citalopram
	Fluoxetine Fluvoxamine Paroxetine Sertraline Diazepam
Antileprosy agents	Clofazimine
Antirheumatic agents/analgesics	Aspirin
	Ibuprofen
Sedatives and hypnotics	Primidone
Drugs secreted in tears	Aspirin
	Chloroquine Clofazimine Docetaxel Ethyl alcohol Hydroxychloroquine Ibuprofen Isotretinoin
Antiandrogens	Tamsulosin
	Terazosin Doxazosin Alfuzosin
Neurotoxins	Botulinum A or B toxin
Antimalarial agents	Chloroquine
	Hydroxychloroquine
Retinoids	Isotretinoin
Antiviral	Aciclovir
Thiazides	Bendroflumethiazide
	Chlorothiazide Chlortalidone Hydrochlorothiazide Hydroflumethiazide Indapamide Methyclothiazide Metolazone Polythiazide Trichlormethiazide
Cannabinoids	Dronabinol
	Hashish Marijuana
Chelating agents	Methoxsalen
Strong analgesics	Morphine
	Opium/opioids
Antipsychotic agents	Pimozide

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*References for the above systemic medications provided at http://www.eyedrugregistry.com/.

Adjuncts to anesthesia	Antipyretic agents
Analgesics	Antirheumatic agents
Antiandrogens	Antispasmodics
Antiarrhythmics	Antivirals
Anticholinergics	Anxiolytics
Antidepressants	Bronchodilators
Antiemetics	Chelating agents
Antihistamines	Decongestants
Antihypertensives	Diuretics
Antileprosy agents	Neurotoxins
Antimalarial agents	Opioids
Antimuscarinics	Psychedelic agents
Antineoplastics	Retinoids
Antiparkinsonians	Sedatives and hypnotics
Antipsychotics

References:
 1. J Ophthalmol. 2012; 2012: 285851.

Published online 2012 Aug 27. doi:  10.1155/2012/285851

PMCID: PMC3459228

PMID: 23050121

The Role of Medications in Causing Dry Eye

Frederick T. Fraunfelder, 1 ,* James J. Sciubba, 2 and William D. Mathers 1

Author information ► Article notes ► Copyright and License information ▼ Disclaimer

Copyright © 2012 Frederick T. Fraunfelder et al.

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

2. Curr Eye Res. 2017 Jun;42(6):827-831. doi: 10.1080/02713683.2016.1255758. Epub 2017 Jan 31.

Comparison of Autologous Serum Versus Preservative Free Artificial Tear in Patients with DryEyes Due to Systemic Isotretinoin Therapy.

Yılmaz U1, Küçük E1, Koç Ç2, Gökler E3.

Isotretinoin is an agent used in severe cystic acne vulgaris. It exerts its effects by reducing sebum secretion from sebaceous glands. In addition, it also reduces secretions of meibomian glands and leads to atrophy. Ocular adverse effects related to isotretinoin use mainly occur due to changes in eyelids and corneal surface pathology resulted from xerophthalmia. Conjunctivitis and blepharitis development have been generally reported in the studies in the literature.1Oner AF, Ferahbas A, Karakucuk S, Utas S, Karaman B, Kutlugun C, et al. Ocular side effects associated with systemic isotretinoin. Cutan Ocul Toxicol 2005;23:189–195.[Taylor & Francis Online], [Web of Science ®], [Google Scholar]–4Bozkurt B, Irkec¸ MT, Atakan N, Orhan M, Geyik PO. Lacrimal function and ocular complications in patients treated with systemic isotretinoin. Eur J Ophthalmol 2002;12:173–176.[PubMed], [Web of Science ®], [Google Scholar] Systemic isotretinoin use can also lead to corneal surface pathologies such as abnormal meibomian gland secretion and atrophy, blepharoconjunctivitis, corneal opacity, decreased tolerance to contact lenses, reduced visual acuity, increased tear osmolarity, xerophthalmia, photophobia, and keratitis.5Fraunfelder FT, Fraunfelder FW, Edwards R. Ocular side effects possibly associated with isotretinoin usage. Am J Ophthalmol 2001;132:299–305.[Crossref], [PubMed], [Web of Science ®], [Google Scholar] Moreover, Fraunfelder et al. reported data suggesting retinal pathologies such as impairment in dark adaptation, blurring, papilledema, and visual field defects.6Fraunfelder FW. Ocular side effects associated with isotretinoin. Drugs Today (Barc) 2004;40:23–27.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]

The most frequent ocular adverse effects are reported as conjunctivitis, hordeolum, chalazion, blepharitis, ocular pain, and dry eye.1Oner AF, Ferahbas A, Karakucuk S, Utas S, Karaman B, Kutlugun C, et al. Ocular side effects associated with systemic isotretinoin. Cutan Ocul Toxicol 2005;23:189–195.[Taylor & Francis Online], [Web of Science ®], [Google Scholar],3Egger SF, Huber-Spitzy V, Bohler K, Raff M, Scholda C, Barisani T, et al. Ocular side effects associated with 13-cis-retinoic acid therapy for acne vulgaris: clinical features, alterations of tear film and conjunctival flora. Acta Ophthalmol Scand 1995;73:355–357.[Crossref], [PubMed], [Google Scholar],7Neudorfer M, Goldshtein I, Shamai-Lubovitz O, Chodick G, Dadon Y, Shalev V.Ocular adverse effects of systemic treatment with isotretinoin. Arch Dermatol 2012 Jul;148:803–808.[Crossref], [PubMed], [Web of Science ®], [Google Scholar],8Chia EM, Mitchell P, Rochtchina E, Lee AJ, Maroun R, Wang JJ. Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study. Clin Exp Ophthalmol 2003;31:229–232.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]

 In ophthalmology clinics, dry eye and ocular discomfort are most common presenting symptoms in the patients receiving isotretinoin.

http://www.dryeyepain.com/Practical1-Med_Surg.htm,


This is a nice summary also:

Which medicines can cause or increase dry eye?

Common medicines that might cause or increase dry eye symptoms include those listed in the following table. For information about new dry eye vitamins and traditional eye compresses that can help alleviate dry eye pain, see the Vitamins & Compresses page. For information about possible side effects for any drug, including drugs not listed in the following table, see the section called How can I find information about the side effects of any medication? later on this Web page.

Drugs	Some People Report Possible Dry Eye Side Effect
Allergy medicines (antihistamines)	Can cause or worsen dry eye. This is true both for many eye drops used for seasonal allergies as well as for many or most over-the-counter allergy medicines.
Artificial tears (for some people)	Can cause or worsen dry eye for some people if they contain preservatives or if you are sensitive or allergic to any of the ingredients. Currently, most artificial tears contain methylcellulose, and some people with dry eye are sensitive or allergic to methylcellulose. Be aware that an allergic reaction can occur days or weeks after you start using a new eye drop.
Anti-depressants	Some, including Diazepam (Valium) and Elavil, can cause or worsen dry eye.
Atropine	Can cause or worsen dry eye.
Beta blockers	Can cause or worsen dry eye.
Blood pressure medications	Can cause or worsen dry eye.
Cataract surgery eyedrops	Some people report an allergic or sensitive reaction to eyedrops used after cataract surgery. See alsoCataract Surgery.
Chemotherapeutic agents	Can cause or worsen dry eye.
Decongestants & decongestant eyedrops	Can cause or worsen dry eye.
Diuretics	Can cause or worsen dry eye.
Glaucoma eyedrops	Can cause or worsen dry eye. According to the Sjogren's Syndrome Foundation newsletter, February 2002, "much of the damage to the eye surface [when using glaucoma eyedrops] is from the preservatives in the eyedrops; it is possible for some pharmacies to compound some of these agents in a non-preserved solution."
Ibuprofen (Advil)	Can cause or worsen dry eye.
Incontinence medicines	Can cause or worsen dry eye.
Methylcellulose	Although methylcellulose is an ingredient in many, possibly most, artificial tears and other dry eye preparations, some people are allergic or sensitive to methylcellulose. If you have tried many eyedrops but find that they don't help or make your dry eye pain worse, try Refresh Lubricant Eye Drops (not the same as Refresh Plus, which does contain methylcellulose). The active ingredients in Refresh Lubricant Eye Drops are polyvinyl alcohol and povidone. You can find Refresh atMedShopExpress.com or Drugstore.com.
Murine eyedrops	Can cause or worsen dry eye.
Niacin	Can cause or worsen dry eye.
Oral contraceptives	Can cause or worsen dry eye.
Plaquenil (hydroxychloroquine)	Can cause or worsen dry eye for some individuals (sometimes prescribed for fatigue caused by Sjogren's).
Provigil	Can cause or worsen dry eye (sometimes prescribed for fatigue caused by Sjogren's).
Refresh Plus	Can make dry eye worse for people who are allergic or sensitive to carboxylmethylcellulose. Instead of Refresh Plus, try Refresh Lubricant Eye Drops (active ingredients: polyvinyl alcohol and povidone). Despite the similar names, Refresh Lubricant Eye Drops and Refresh Plus are completely different products.
Ulcer medications	Some can contribute to dry eye.