pubmed.ncbi.nlm.nih.gov

A review on drug-induced dry eye disease - PubMed

Review

A review on drug-induced dry eye disease

Ka Wai Kam et al. Indian J Ophthalmol. 2023 Apr.

Abstract

Dry eye disease encompasses a broad range of etiologies and disease subtypes which have similar clinical manifestations. Medications can cause dry eye disease or symptoms of dryness as a side effect by either interfering with the lacrimal gland or meibomian gland function, or both, and by other mechanisms that affect the ocular surface homeostasis. This is important to know and recognize as eliminating the offending medication can reverse the symptoms and, in many cases, prevent further deterioration of the ocular surface inflammation. This review focuses on drugs like systemic isotretinoin and taxanes, which cause meibomian gland dysfunction; immune checkpoint inhibitors that cause lacrimal gland dysfunction; gliptins and topical antiglaucoma medications that cause cicatrizing conjunctivitis; and epidermal growth factor receptor inhibitors, fibroblast growth factor receptor inhibitors, and belantamab mafodotin, which cause mucosal epitheliopathy. Many of these medications, particularly the newer anticancer agents, have only recently been introduced for clinical use, and knowledge and awareness of their ocular side effects are still evolving. This review aims to update ophthalmologists on the drug-induced causes of dry eye disease or symptoms of dryness, which is avoidable by discontinuation of the incriminating agent or can be mitigated by reducing the dose or frequency of usage.

Keywords: Drug-induced cicatrizing conjunctivitis; drug-induced dry eye disease; meibomian gland dysfunction.

PubMed Disclaimer

Conflict of interest statement

None

Figures

Figure 1
Figure 1

Dry eye and ocular surface disease caused by various systemic and topical drugs. (a) Isotretinoin-induced complete meibomian gland loss and severe evaporative dry eye; (b) EGFR-induced limbal and peripheral corneal epitheliopathy and dry eye; (c) Gliptin-induced dry eye; (d) Topical decongestant-induced cicatrizing conjunctivitis with medial canthal keratinization

Figure 2
Figure 2

Before (top row) and after (bottom row) photographs of a patient with severe inflammation, dryness, and corneal ulceration due to chronic use of topical timolol maleate eyedrops. The top row shows the presence of conjunctival inflammation in both bulbar and palpebral regions (A1, C1), and a paracentral corneal ulceration with epithelial defect (B1). The bottom row shows the resolution of conjunctival inflammation (A2, C2) and corneal ulceration (B2) following the withdrawal of the medication and use of preservative-free lubricants

Similar articles

Cited by

References

    1. Fraunfelder FT, Sciubba JJ, Mathers WD. The role of medications in causing dry eye. J Ophthalmol. 2012;2012:285851. - PMC - PubMed
    1. Gomes JAP, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, et al. TFOS DEWS II iatrogenic report. Ocul Surf. 2017;15:511–38. - PubMed
    1. Lambert RW, Smith RE. Pathogenesis of blepharoconjunctivitis complicating 13-cis-retinoic acid (isotretinoin) therapy in a laboratory model. Invest Ophthalmol Vis Sci. 1988;29:1559–64. - PubMed
    1. Lambert RW, Smith RE. Effects of 13-cis-retinoic acid on the hamster meibomian gland. J Invest Dermatol. 1989;92:321–5. - PubMed
    1. Kremer I, Gaton DD, David M, Gaton E, Shapiro A. Toxic effects of systemic retinoids on meibomian glands. Ophthalmic Res. 1994;26:124–8. - PubMed

Publication types

MeSH terms