Eyeworld

I JANUARY/FEBRUARY 2020 | EYEWORLD | 59 Antihistamines Oral antihistamines taken for allergies are another culprit. Dr. Yeu noted a study that showed 4 days of continuous loratadine use— the antihistamine in Claritin (Bayer)—caused an increase in conjunctival staining and decreased tear film breakup time. 1 "That shocked me," Dr. Yeu said, adding that it caused her to start discussions with dry eye patients taking these medications about switching to localized allergy therapy vs. system- ic. "For example, if they have allergic conjunc- tivitis or retinitis, these are candidates where maybe we can switch them over to Singulair [Merck], which does not have these drying ef- fects, or a nasal spray for more local control." Dr. Trattler said some patients with allergies might be willing to change medications to alle- viate dry eye issues, but others who have, after trial and error, found an allergy medication that works for them, might be less willing. Dr. Singleton noted use of topical anti-al- lergy medications as a potential problem for dry eye. "Sometimes topical allergy medications don't necessarily cause dry eye, but if you over they could potentially be using," Dr. Singleton said. Even the patient's age can help you iden- tify what could be going on with their ocular surface. "In a young patient with severe dry eye, there may be more going on with that patient systemically than your typical young patient who should not have dry eye because, in general, they have good tear film," Dr. Singleton said. High blood pressure, allergies, skin condi- tions, mental illnesses, incontinence, and more are all things on a medical history that could trigger an ophthalmologist to think about med- ications that could be causing or exacerbating a patient's dry eye. Diuretics Patients who have high blood pressure are often on beta blockers, which are diuretics, Dr. Yeu said. Diuretics can have a drying effect on the ocular surface. Caffeine is also a very common diuretic. Dr. Singleton said asking a patient with dry eye to decrease their caffeine intake and increase their water consumption can have a simple, positive effect. Figure 1. Meibography shows significant meibomian gland dropout in a patient who had previously been on Accutane 20 years prior. Source: Jennifer Loh, MD About the doctors Chasidy Singleton, MD Chief of ophthalmology Nashville General Hospital Nashville, Tennessee William Trattler, MD Director of Cornea Center for Excellence in Eye Care Miami, Florida Elizabeth Yeu, MD Virginia Eye Consultants Norfolk, Virginia References 1. Ousler GW, et al. An evaluation of the ocular drying effects of 2 systemic antihistamines: lorata- dine and cetirizine hydrochloride. Ann Allergy Asthma Immunol. 2004;93:460–4. 2. Fraunfelder, et al. The role of medications in causing dry eye. J Ophthalmol. 2012;285851. 3. Kocer E, et al. Dry eye related to commonly used new antide- pressants. J Clin Psychopharma- col. 2015;35:411–3. 4. Ozen TZ, et al. Dry eye findings worsen with anticholinergic therapy in patients with urge incontinence. Int Urogynecol J. 2016;27:919–22. continued on page 60

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