Dry Eye Pills by Mouth: which pills make a dry eye better, and which pills make Dry Eye worse?

Many patients ask if there are any pills that they could take to help with her dry eye symptoms.

Classically omega-3 2000 mg to 4000 mg has been used in as an option to help with dry eye symptoms. Publish studies have been mixed on the effectiveness of omega-3 for dry eye symptoms.  However, so much data has shown that omega-3 helps with so many systems of the body that it makes sense to increase your omega-3 intake. 

Whether omega-3 is worth the money is still unclear and controversial. 

I try to increase my omega-3 intake, naturally eating wild salmon, at least once a week, eating, Chia seeds and flaxseeds and walnuts whenever I can. I do try to take a supplement of omega-3 in the winter time. I must admit that I’m not consistent as I’m not a big fan of pills. 

Check with your MD before starting any new medications.

Pills that help dry eyes:

1. Omega 3: likely yes. Mixed results in prospective, randomized studies. Low risk. Check with your MD before starting any new medications.

2. Doxycycline 20 mg a day: this is a personal favorite as it decreases inflammation especially for cancer patients and rosacea patients. If I had severe dry eye disease and rosacea, I would take Doxy 20mg once a day. The risks are low, but it can include stomach upset. The risk of having a sunburn with light exposure is also very low. Most patient should not drop the pill cannot be used if you were pregnant. The risks of a severe negative reaction is rare. 

3. Hormone therapy: the use of estrogen and progesterone specifically for women that are perimenopausal or postmenopausal is also controversial. Some patients report feeling better with oral progesterone, or estrogen and many patient reported feeling worse. There’s no randomized controlled perspective studies that I know of indicating that these are reliable treatments. Sometimes a patient have to give it a try before they can see if it helps them.

4. Cholinergic, such as pilocarpine, and cevimeline are known as are known to increase aqueous tear production (the watery part of the test). For some patients this does help, but without an increase in the oil production, with each blink, I find this medication’s to not be as effective. 

Pills that make dry eye symptoms worse: a large percentage of drugs taken by mouth have dry eye symptoms as a side effect listed in the insert packaging. Below are the most common ones.

1. Anti-cholinergic pills: all make dry eye worse.

atropine (Atropen)

belladonna alkaloids

benztropine mesylate (Cogentin)

clidinium

cyclopentolate (Cyclogyl)

darifenacin (Enablex)

dicylomine

fesoterodine (Toviaz)

flavoxate (Urispas)

glycopyrrolate

homatropine hydrobromide

hyoscyamine (Levsinex)

ipratropium (Atrovent)

orphenadrine

oxybutynin (Ditropan XL)

propantheline (Pro-banthine)

scopolamine

methscopolamine

solifenacin (VESIcare)

tiotropium (Spiriva)

tolterodine (Detrol)

trihexyphenidyl

trospium

2. 

Not all antidepressants work this way. Tricyclic antidepressants do, but Selective serotonin reuptake inhibitors (SSRIs) work differently. 

The second generation, or atypical antidepressants, and the newer selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) are considered to be useful alternatives to tricyclics. These drugs possess greatly diminished anticholinergic activity and less dry eye risk. 

Another approach to avoiding anticholinergic effects is to use reversible inhibitors of monoamine oxidase (MAO)-A (RIMAs), such as moclobemide but this category has other risks and can still cause dry eye symptoms though less. 

Antihistamines

Antihistamines counteract allergic reactions like rhinitis, urticaria, dermatitis and other systemic allergies. First generation antihistamines worked as muscarinic receptor antagonists which could lead to serious anticholinergic side effects, such as sinus tachycardia, dry skin, dry mucous membranes, dilated pupils, constipation, ileus, urinary retention, and agitated delirium.

Benadryl and Claritin have been reported to have these side effects for some. Some newer, more site-specific antihistamines like Zyrtec, Clarinex, and Allegra have less reported ocular dryness.

Decongestants

Decongestants affect mucous production, which decisively hinders the mucin layer. The mucin layer acts as the glue for holding the tear film against the eye’s surface — so dry eye symptoms can be severe.

Hormone Replacements & Birth Control

For unclear reasons, birth control and hormone replacement therapy (HRT), an artificial source of estrogen and progesterone, appears to interfere with adequate aqueous layer production. There’s about a 29% increase in dry eye symptoms when taking estrogen and progesterone together compared to estrogen alone.

Hypertension Medication

High blood pressure meds fall under hypertension medication. They deploy beta-blockers to the bloodstream for decreased blood pressure. They can affect the lacrimal gland, leading to dry eye symptoms. Beta-blockers also seem to induce a loss of feeling in the cornea and overall eye irritation.

Acne Control Medication

Vitamin A, and its derivatives, treat several kinds of acne and psoriasis effectively. But Isotretinoin (13-cis-retinoic acid) (ie Accutane) is a form of vitamin A alters water production from the lacrimal gland which in turn hinders meibomian gland production.

Parkinson’s Disease Medication

These block overactive receptors between nerves and muscles which can affect the eye’s delicate glands. 

Pain Relievers

Pain relievers like ibuprofen, Darvocet-N, and Lortab all produce dry eye symptoms as a side effect. Ibuprofen, in particular, can produce other side effects like blurred vision, refractive changes, diplopia and colour vision changes.

Gastrointestinal Medications

Prevacid (lansoprazole, Takeda), Prilosec (omeprazole, Procter & Gamble), Nexium (esomeprazole magnesium, AstraZeneca), Zantac (ranitidine, GlaxoSmithKline) and Tagamet (cimetidine, GlaxoSmithKline) all have been reported to cause dry eye symptoms. 

All H2 receptor inhibitors or proton pump inhibitors (PPIs) can cause dry eye. 

Chemotherapy Medications

Most chemo drugs cause dry eye. Cytoxan (cyclophosphamide, Bristol-Myers Squibb) is used to treat both ocular cicatricial pemphigoid and primary Sjogren syndrome and causes dry eye symptoms in as many as 60% of patients.

Antipsychotic Medications

Thorazine (chlorpromazine, GlaxoSmithKline), Phenothiazines, including Mellaril (thioridazine, Mutual Pharmaceutical), in the treatment of schizophrenia.