Proton Pump Inhibitors, Antiglaucoma Meds Linked to Dry Eye

Female ophthalmic doctor diagnosing elderly patient`s sight using ophthalmic equipment
Female ophthalmic doctor diagnosing elderly patient`s sight using ophthalmic equipment
Despite prior suspicion, the review shows no link between dry eye disease and antidepressants or antihypertensives.

Proton pump inhibitors (PPIs), antiglaucoma and anticholinergic medications are significantly associated with dry eye symptoms, according to a study published in The Ocular Surface. This large, population-based research notes that medication use should always be evaluated in every patient with dry eyes.

Previous studies on the association between dry eye disease and medications are lacking. Therefore, researchers explored the association between dry eye symptoms and both medication classes and individual drugs, utilizing a hypothesis-free approach. 

A total of 79,606 participants (age range: 20-97 years, 59.2% women) from the population-based Lifelines cohort in the Netherlands were included in the current study. Participants completed the Women’s Health Study dry eye questionnaire between 2014 and 2017. All medications used were registered and coded via the Anatomical Therapeutic Chemical (ATC) drug classification system. The investigators used logistic regression to examine the risk of the 59 most-used therapeutic/pharmacological subgroups and the 99 most-used individual drugs on dry eye symptoms, correcting for age, sex, body mass index, and 48 comorbidities associated with dry eye.  

After correction for age and sex only, 38 (64%) medication subgroups and 52 (53%) individual drugs were associated with dry eye symptoms (P <.05). Drugs for peptic ulcer and gastro-esophageal reflux disease (GERD) (OR 1.24, 95% CI 1.17–1.31) showed the strongest association with dry eye symptoms at the ATC 3rd level. PPIs (OR 1.24, 95% CI 1.16–1.32) were associated with the highest risk of dry eye symptoms at the ATC 4th level. Antiglaucoma preparations and miotics (OR 1.32, 95% CI 1.06–1.66) were also associated with a risk of dry eye symptoms. Synthetic anticholinergics (OR 1.36, 95% CI 1.03–1.78) and other antiepileptics’ (OR 1.29, 95% CI 1.01–1.65) were associated with a greater risk of dry eye symptoms at the ATC 4th level.

The researchers note that, contrary to previous research, after adjustment for underlying comorbidities, antidepressants and antihypertensives were not associated with dry eye symptoms. 

The cross-sectional assessment of dry eye symptoms and medication use may be considered a limitation of this study. Additionally, the WHS questionnaire only evaluates the frequency, not the severity, of dry eye symptoms.

“The novel link between PPIs and dry eye symptoms deserves particular attention given how commonly they are prescribed,” according to the study authors. 

Disclosure: Some study authors declared affiliations with the industry. Please see the original reference for a full list of authors’ disclosures. 


Wolpert LE, Snieder H, Jansonius NM, Utheim TP, Hammond CJ, Vehof J. Medication use and dry eye symptoms: A large, hypothesis-free population-based study in the Netherlands. Ocul Surf. Published online June 23, 2021. doi:10.1016/j.jtos.2021.06.009 

This article originally appeared on Ophthalmology Advisor