Medications & Surgery

Some Medications and Surgery Might Contribute to Dry Eye Pain

Over-the-counter and prescription medicines, as well as eye surgery or general surgery, can pose extra challenges — in the form of increased pain — for people with severely dry eyes. This page covers:

Whenever you plan to take a new medication or expect to undergo surgery, make sure that your physician/surgeon understands that your dry eye problem is a factor that needs to be considered.

Important!    If the advice of your physician or surgeon differs from any information provided on this Web site, be sure to follow the advice of your doctor. Please also see the Disclaimer below.

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 also Cataract 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 at MedShopExpress.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.

Be aware that sensitivity to light (photophobia) is one of the possible symptoms of dry eye.

Do these medications always cause dry eye?

No. Just because a medication causes dry eye in one person, it does not necessarily mean that it will increase the dryness of your eyes.

Typically, a doctor will not warn you that a drug might cause dry eye. This may be because the doctor is too busy to look it up, or because he or she may worry that suggesting that the drug could cause dry eye will make you predisposed to experience dry eye symptoms.

A good strategy when prescribed a new drug is to do the following:

  • Do not refer to this list (or any other source of information about drug side effects) in advance.
  • Take the first dose of the drug on Friday evening or Saturday morning (or when you are on vacation) so that if it does cause symptoms you won't have to take time off from work.
  • If you do experience dry eye symptoms after taking the drug for a day or two (or after taking it for a week or two), refer to this list, read the fine print on the insert that the pharmacist provides with the drug, and refer to the sources listed in How can I find information about the side effects of any medication?.

If a medicine that you are taking does cause or increase your dry eye symptoms, ask your doctor or pharmacist if an alternative is available.

How can I find information about the side effects of any medication?

You can check the following sources to find out what the side effects are for a given medication:

What should I do to prepare for non-eye surgery?

If you have severely dry eyes (or even moderately dry eyes) and plan to undergo any type of surgery, be sure to tell both the surgeon and the anesthesiologist that you have dry eyes. It might be helpful for the surgeon or the anesthesiologist to talk to your ophthalmologist before the date of surgery.

Discuss with your ophthalmologist and/or surgeon whether it would be appropriate for you to bring some of your usual eye medications, such as artificial tears, so that a nurse can put them in your eyes while you are unconscious.

If you are allergic to any eyecare products, ask the surgeon and anesthesiologist if any prescription or non-prescription product is routinely put into the eyes of someone undergoing the surgery you are about to have. Be sure that the surgeon and anesthesiologist understand what your eye allergies are. For example, if your eyes are allergic to vaseline, request that no vaseline-based product is put into your eyes and that a suitable alternative be used instead.

Which types of eye surgery can cause or increase dry eye?

Some people with dry eye may experience a temporary or permanent increase in dry eye symptoms after some types of eye surgery. The following sections describe dry eye problems that might arise for some individuals undergoing the following types of eye surgery:

Lasik Surgery

If you would like to undergo eye surgery to improve your vision, ask the surgeon to evaluate your dry eye condition to see if such surgery is appropriate for you. Many people report a temporary or permanent increase in dry eye pain after such surgery.

The following table lists a few sources that indicate that dry eyes might be worsened by, or result from, elective eye surgery.

Source What they say about LASIK surgery and dry eye
FDA According to " LASIK Eye Surgery: What are the risks?," an article published on the U.S. Food and Drug Administration web site, one of several risks of lasik surgery is the risk that "Some patients may develop severe dry eye syndrome. As a result of surgery, your eye may not be able to produce enough tears to keep the eye moist and comfortable. Dry eye not only causes discomfort, but can reduce visual quality due to intermittent blurring and other visual symptoms. This condition may be permanent."
Ophthalmology Times According to " Awareness facilitates treatment of LASIK-associated dry eye," published in Ophthalmology Times in May 15, 2003), a study shows that "dry eye is both the most common complication after LASIK as well as the most common reason for patient dissatisfaction" and that "up to 80% of patients who undergo LASIK experience symptoms of dry eye postoperatively."
Eric D. Donnenfeld, MD According to "Prevention and Management of Post-LASIK Dry Eye," an online medical lecture dated March 2004 given by Eric D. Donnenfeld, MD, dry eye is a potential complication of lasik surgery. His first slide states: "The most common and potentially one of the most devastating ... complications of LASIK is dry eye." A later slide states, "Every patient gets dry eye after lasik." He mentions severing of the corneal nerve as one possible cause of post-lasik dry eye, and also mentions several other possible causes, including specific surgical techniques.
SurgicalEyes.org According to SurgicalEyes.org, undergoing surgery to correct vision is reported to cause or increase dry eye pain for some people. The goal of the Surgical Eyes Web site is to assist people who have had unsuccessful LASIK, PRK, RK, AK, ALK or other elective refractive and laser surgeries.
DryEyeInfo.org According to the DryEyeInfo.Org Web site, people without Sjogren's Syndrome can also have dry eye and thus dry eye pain: "Tear production can also decrease from any condition that decreases corneal sensation.... Causes for decreased corneal sensation include long-term contact lens wear, LASIK eye surgery, trauma to the 5th nerve, and certain viral infections.
LadarVision.com According to the LadarVision.com safety page, "People with the following conditions should not have LASIK: ... Blepharitis (inflammation of the eyelids with crusting of the eyelashes....)" (and you might want to also take a look at the other conditions listed on that page). According to the LadarVision.com risks page, "In some cases, LASIK surgery may result in an inability to produce enough tears to keep eyes moist. This complication is the most common among LASIK side effects. Most patients suffer mildly from this for a short period of time.... The condition, however, can cause discomfort and may be permanent."
Sjogren's Syndrome Foundation newsletter (11/02) According to a Japanese study of 290 people who underwent LASIK surgery, some of whom had healthy eyes and some of whom were classified as having dry eyes or probable dry eyes, "patients with dry eyes can have significant dry eye symptoms, which may worsen after [LASIK] surgery. Those with probable dry eyes are also at risk for worsening dry eye criteria."

Blepharoplasty (Eyelid) Surgery

Blepharoplasty is cosmetic eyelid surgery performed to improve appearance, such as droopy or puffy eyelids or bags under the eyes.

Blepharoplasty is reported to cause severe dry eye pain in some people, especially people who already have dry eyes. For sources that mention dry eye as a possible complication of blepharoplasty, see "Don't Blink at Informed Consent," an article published in the 1/15/03 issue of Review of Ophthalmology; see the article "The 'dry eye' complication after a blepharoplasty" (in the medical journal Plast. Reconstr. Surg. 1975 Oct;56(4):375-80 — you can ask your local librarian to order you a copy of this article); or search Google.com for [blepharoplasty "dry eye"].

Cataract Surgery

Typically, cataract surgery is not more difficult for someone with dry eyes than for anyone else — except that you might experience dry eye pain temporarily (for a few days or a few weeks) afterwards. Occasionally, someone reports a permanent increase in dry eye pain following cataract surgery. Therefore, people with severe dry eyes should not request to have cataract surgery before they really need it.

If you tend to have have a lot of eye allergies, two or three weeks after surgery you might develop an allergic or sensitive reaction to eyedrops prescribed for post-cataract care, such as Tobradex and Voltaren Ophthalmic. According to the Physician's Desk Reference, in "cataract surgery studies, keratitis [dry eye] was reported in up to 28% of patients receiving Voltaren Ophthalmic, although in many of these cases keratitis was initially noted prior to the initiation of treatment." Because you are supposed to use these eyedrops for 60 days after surgery, you may want to plan for the possibility that you might be out of work for up to 60 days.

DISCLAIMER: Do not use any tip described on these pages without first consulting your physician.
All content on this Web site is for informational purposes only; it is not to be used for diagnosis or treatment; and it should not be construed as personal medical advice. Information published on this Web site is not intended to replace, supplant, or augment a consultation with an eye care professional regarding the user's/viewer's medical care. Every effort has been made to present accurate and safe information, but the creator of the Web site is not a health care professional, does not warrant the correctness of the information, and is not liable for any direct or consequential injury or other damages that could result from the use of the information obtained from this site. Products are mentioned as examples only. No mention of a product constitutes an endorsement for that product; other products may be successfully used for dry eye and other conditions described here. It is not the intent of this Web site to promote any eye care products, procedures, or medications.