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Journal of Ophthalmology
Volume 2012, Article ID 285851, 8 pages
Review Article

The Role of Medications in Causing Dry Eye

1Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 3375 SW Terwilliger BouLevard, Portland, OR 97239-4197, USA
2The Milton J. Dance , Jr. Head & Neck Center, 6569 North Charles Street, Baltimore, MD 21204, USA

Received 25 June 2012; Revised 14 August 2012; Accepted 21 August 2012

Academic Editor: Anthony J. Bron

Copyright © 2012 Frederick T. Fraunfelder et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The purpose of this paper is to review the possible role of polypharmacy in causing dry eye disease (DED), reflecting the complex interactions and complications associated with the use of multiple systemic and topical ocular medications. The pharmacological, physiological, anatomical, and histological mechanisms causing dry mouth differ little from those causing dry eye. Oral polypharmacy is the most common cause of dry mouth, but has not been investigated as a cause of dry eye. Topical ocular polypharmacy has been shown to cause DED. Information on drugs that likely cause or aggravate DED and the controversial role of preservatives in topical ocular medications are examined. Systemic or topical ocular medications and preservatives used in topical ocular drugs may cause dry eye through the drug's therapeutic action, ocular surface effects, or preservatives, and the effects probably are additive. Long-term use of topical ocular medications, especially those containing preservatives such as BAK, may play an important role in DED and the role of polypharmacy needs further study. We review possible ways to decrease the risk of medication-related dry eye.