Which medications cause dry eyes?

The most common are antihistamines and decongestants, antidepressants and anxiety or sleep medications, antipsychotics, anticholinergic bladder and Parkinson’s drugs, diuretics and beta blockers, hormone therapy and anti-androgens, isotretinoin, and several chemotherapy, targeted and immunotherapy drugs. Most block the nerve signal that drives tear secretion or damage the oil glands in the eyelids.

Can antihistamines cause dry eyes?

Yes. Antihistamines block acetylcholine, the nerve messenger that tells the lacrimal gland to make tears, so tear volume falls. First-generation drugs such as diphenhydramine (Benadryl) dry the most, but cetirizine, loratadine and fexofenadine can also thin the tear film with daily use.

Does Accutane cause permanent dry eye?

It can. Isotretinoin shrinks the meibomian oil glands, and gland loss on meibography can persist a year after treatment and may be permanent. Most patients improve after the course, but some develop lasting meibomian gland dysfunction, so we image the glands before and after treatment and treat early.

Do antidepressants cause dry eyes?

Many do. Tricyclics such as amitriptyline are strongly anticholinergic and very drying. SSRIs such as sertraline and escitalopram and SNRIs such as duloxetine dry less directly but are linked to more dry eye symptoms. The eye can be treated without changing the antidepressant.

Should I stop my medication if it causes dry eye?

No. Never stop, skip or change a prescribed medication because of dry eye without talking to the doctor who prescribed it. The Dry Eye Center treats the eye with tears, plugs, prescription drops or gland treatment and coordinates with your prescriber, who decides whether a change is safe.

Medications That Cause Dry Eye: Pills to Patches

If your eyes turned dry a few weeks after a new prescription, the prescription may be the reason. The TFOS DEWS II Iatrogenic Report lists analgesic, anticholinergic, antidepressant, antihistamine, antihypertensive, antineoplastic, anxiolytic, hormonal and sedative drugs among the systemic medications that can cause dry eye. This guide covers medicines you swallow, inject, infuse, inhale or wear on the skin. Eye drops that dry the eye have their own article, and diseases are covered in our broader overview. At the Dry Eye Center at Eye MDs of Inland in Upland, a line-by-line medication review is part of every evaluation.

Never stop, skip or change a prescribed medication because of dry eye without talking to the doctor who prescribed it. The Dry Eye Center coordinates with your prescriber and treats the eye.

Illustration of an eye orbited by line icons of a capsule, a syringe, a skin patch, an inhaler and a tablet blister pack, representing the medications that can cause dry eye

1. Antihistamines and decongestants

The lacrimal gland makes tears when the nerve messenger acetylcholine tells it to. First-generation antihistamines block that signal (an anticholinergic effect), so tear volume drops along with saliva. Second-generation antihistamines and decongestants are gentler but can still thin the tear film, especially with daily use.

Diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton)
Cetirizine (Zyrtec), loratadine (Claritin), fexofenadine (Allegra)
Pseudoephedrine (Sudafed)

What we do: suggest allergy control that spares the tear film, such as nasal steroid sprays or antihistamine eye drops, and add preservative-free tears.

2. Antidepressants, anxiety and sleep medications

Tricyclics are strongly anticholinergic and are among the most drying drugs in use. SSRIs and SNRIs dry less directly but change serotonin signaling in the lacrimal gland and cornea, and users report more symptoms. Benzodiazepines and sleep aids reduce the blink rate and tear reflex.

Tricyclics: amitriptyline (Elavil), nortriptyline (Pamelor), imipramine (Tofranil)
SSRIs: sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), escitalopram (Lexapro)
SNRIs: venlafaxine (Effexor), duloxetine (Cymbalta); also bupropion (Wellbutrin)
Alprazolam (Xanax), lorazepam (Ativan), zolpidem (Ambien)

What we do: treat the eye; if a swap is worth exploring, your prescriber leads it.

3. Antipsychotics

Most antipsychotics carry anticholinergic activity that lowers tear secretion, and sedation reduces blinking. Chlorpromazine can also deposit in the cornea and lens after years of use.

Quetiapine (Seroquel), olanzapine (Zyprexa), risperidone (Risperdal), chlorpromazine (Thorazine)

What we do: lubrication, punctal plugs and a slit-lamp check for deposits.

4. Anticholinergics for bladder, gut and Parkinson’s disease

These drugs are designed to block acetylcholine, so a dry mouth and dry eyes are expected side effects rather than surprises. The scopolamine patch shows that a medicine worn on the skin reaches the lacrimal gland just as a pill does.

Bladder: oxybutynin (Ditropan), tolterodine (Detrol), solifenacin (Vesicare)
Gut: hyoscyamine (Levsin), dicyclomine (Bentyl)
Parkinson’s: benztropine (Cogentin), trihexyphenidyl (Artane)
Motion sickness: scopolamine patch (Transderm Scop)

What we do: plugs or Lacrifill canalicular gel, since the problem is low tear volume.

5. Blood pressure and heart medications

Diuretics lower fluid throughout the body, tears included. Beta blockers reduce tear secretion and can lower corneal sensation, which weakens the reflex that drives tearing. Clonidine is drying through a similar nerve pathway, and amiodarone also leaves whorl-shaped deposits in the cornea that are usually harmless but need monitoring.

Diuretics: hydrochlorothiazide (Microzide), chlorthalidone (Thalitone), furosemide (Lasix)
Beta blockers: metoprolol (Lopressor), atenolol (Tenormin), propranolol (Inderal)
Clonidine (Catapres); amiodarone (Pacerone)

What we do: plugs and tears for volume, and a corneal exam for anyone on amiodarone.

6. Hormones and hormone blockers

Androgens keep the meibomian (oil) glands producing the oil layer that stops tears from evaporating. Estrogen therapy and anti-androgens lower that support, so meibomian gland dysfunction (MGD) follows. Aromatase inhibitors and tamoxifen, used for breast cancer, affect both the lacrimal and meibomian glands.

Oral contraceptives; menopausal hormone therapy (Premarin, Estrace)
Anti-androgens: spironolactone (Aldactone), finasteride (Propecia, Proscar)
Aromatase inhibitors: anastrozole (Arimidex), letrozole (Femara); tamoxifen (Soltamox)

What we do: meibography and LipiFlow thermal pulsation for the oil glands.

7. Isotretinoin and other acne or skin drugs

Isotretinoin shrinks oil glands everywhere, including the meibomian glands, which is why it clears acne. The glands atrophy, the oil layer thins and tears evaporate; gland loss seen on meibography can persist a year after the course ends and may be permanent. The Absorica label lists dry eyes, corneal opacities, keratitis and contact lens intolerance during and after treatment.

Isotretinoin (Absorica, Claravis, Amnesteem; formerly Accutane)
Acitretin (Soriatane) for psoriasis

What we do: image the glands before and after a course, and treat MGD early with LipiFlow and lid care.

8. Chemotherapy, targeted therapy and immunotherapy

Several cancer drugs are secreted into the tears and are directly toxic to the corneal surface, the goblet cells that make mucin, or the tear drainage ducts. Antibody drug conjugates carry a payload that reaches the cornea; belantamab mafodotin caused dry eye in 51 percent of patients in its DREAMM-7 trial and carries a boxed warning requiring an eye exam before every dose. Immune checkpoint inhibitors can trigger a Sjogren’s-like syndrome with dry mouth and dry eye, usually a few months into treatment.

5-fluorouracil, capecitabine (Xeloda), docetaxel (Taxotere), paclitaxel (Taxol)
EGFR inhibitors: erlotinib (Tarceva), cetuximab (Erbitux), panitumumab (Vectibix)
Antibody drug conjugates: belantamab mafodotin (Blenrep), trastuzumab deruxtecan (Enhertu)
Checkpoint inhibitors: pembrolizumab (Keytruda), nivolumab (Opdivo), ipilimumab (Yervoy)

What we do: exams timed to your infusions, serum tears for surface toxicity, and Sjogren’s-style care for immunotherapy sicca, in coordination with your oncologist.

9. GLP-1 drugs

Semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) are not proven causes of dry eye. A 2026 review found the human evidence limited and mixed: diabetic cohorts showed lower dry eye rates in users, while rapid weight loss can shift the tissue around the eye and change how the lids spread tears. Dehydration may add to dryness. What we do: look for another cause first.

10. Other medicines worth knowing

Opioids and cannabinoids (hydrocodone, oxycodone, THC) reduce tear secretion and blinking.
Oral bisphosphonates (alendronate, Fosamax) and long-term systemic steroids can inflame or thin the ocular surface.
Botulinum toxin (Botox) near the eye can weaken lid closure and blinking, so tears evaporate until the effect wears off.
Inhaled anticholinergics for COPD, tiotropium (Spiriva) and ipratropium (Atrovent), dry the eye the way oral anticholinergics do.
Radioactive iodine for thyroid disease concentrates in the lacrimal gland; one cohort found dry eye symptoms in about one in four patients in the first year, usually fading.

How to tell if a medication is the cause

Timing is the strongest clue: dryness that began within weeks of a new drug or a dose increase. Dry mouth, dry skin or constipation alongside dry eye points to an anticholinergic effect. At the Dry Eye Center, your dry eye evaluation starts with a review of every medication; then measure tear production with the Schirmer test, stain the cornea with fluorescein and lissamine green, and image the meibomian glands, so the pattern of damage can be matched to the drug.

What we can do without stopping your medication

Most patients keep the medicine and treat the eye. Options include preservative-free tears, punctal plugs or Lacrifill canalicular gel to hold tears longer, prescription drops in the cyclosporine or lifitegrast class, Tyrvaya nasal spray or Tryptyr drops to boost natural tear production, LipiFlow for gland disease, and autologous serum tears for surface toxicity. Learn more at the Dry Eye Center.