The recent January 2013 issue of Plastic and Reconstructive Surgery Journal was filled with interesting articles. This one out of Cleveland “Pharmaceutical and Herbal Products That May Contribute to Dry Eyes” caught my eye.
Dry eyes are eyes which feel itchy, scratchy, need artificial tears frequently, or water easily. For us as plastic surgeons we frequently perform eyelid surgery, known as blepharoplasty. One of the known side effects, particularly of doing surgery of the lower eyelid, is increased symptoms of dry eye. Are there medications as well which cause this issue?
This was a review study of the literature on dry eye. It surveyed all articles from 1991-2011 and found 36 articles looking at risk factors for dry eye and any association with medications and herbals. It is estimated 8% of women and 5% of men have dry eye disease. It is higher in the elderly. Tears are 98% water adn 2% solids. They are a mixture of lipids (fat) , water, and mucin made by the lacrimal glands and meibomian glands. The autonomic and cholinergic nervous systems control the glands.
Major medication groups causing dry eye:
- Antihistamines and Decongestants. why? They are meant to dry you out. This leads to less water and mucin output. (22% of those using these medications have dry eye symtoms vs. 10% of non users)
- Antidepressants. why? those with structures similar to atropine, an anticholinergic and antimuscarinic
- Anticonvulsants. why? anticholinergic.
- Antipsycholtics.
- Antiparkinson drugs.
- Beta blockers. why? decrease in water
- Hormone replacement therapy. why? sex horones affect teh tear secreation and gland function. dry eyes are worse in women who do hormone replacement.
- Retin A
- Herbals: Niacin, echinacea, and kava are the best known.
Not all medications in these categories cause an increase, but many very common medications were on the list. For further detailed information, see the article in full PRS, symptomatic dryness of the eyes, January 2013, pages 159-166.