Print to PDF
  • About Us
  • Privacy
  • Contact Us

Contact Lens Update

Clinical Insights Based in Current Research

Search Our Site

  • Home
  • Browse Past Issues
  • Resource Library
  • Back to Basics
  • Useful Links
  • About Us
  • Contact Us

Summary: Iatrogenic report – Dry eye disease caused by a medical treatment or procedure

October 6th, 2017

Download PDF

Doerte LuensmannDoerte Luensmann is a clinical scientist at the Centre for Contact Lens Research, in the School of Optometry and Vision Science at the University of Waterloo. 

Gomes JAP, Azar DT, et al. TFOS DEWS II Iatrogenic report. Ocul Surf 2017;15(3): 511-538.

The use of systemic and ocular medications or treatments can result in dry eye disease by impacting tear production and tear stability. Surgical procedures can further damage corneal nerves, which may result in dry eye disease directly or increase the condition in pre-existing dry eye patients.

Systemic medications

Systemic medications may cause dry eye due to reduced tear production, altered nerve input and reflex secretion, inflammatory effects on the various tear glands or direct irritation through secretion into the tears.

Examples of systemic medications: (e.g. antidepressants, antihypertensives, antihistamines, anti-inflammatory medications, steroids, hormone replacement therapy)

Topical ocular medications

Topical medications may result in dry eye due to allergic, toxic and/or immunoinflammatory effects. They do so by disrupting the lipid layer through detergent tensioactive effects or by reducing tear production. There can also be damage to goblet cells, the conjunctival and corneal epithelia, corneal nerves or even eyelids at the skin or meibomian gland level.

Examples of topical medications: (e.g. glaucoma medications, allergy medications, antiviral agents, decongestants, miotics, mydriatics, cycloplegics, preservatives, topical and local anesthetics)

Glaucoma medications containing preservatives such as benzalkonium chloride (BAK) are more likely to cause dye eye symptoms compared to non-preserved products.

Ophthalmic surgeries

LASIK and PRK may cause transient or permanent dry eye symptoms in up to 19% of patients due to neurotrophic effects of the surgery.

Cataract surgery is typically performed on older patients who have a higher incidence of pre-existing dry eye. Corneal denervation due to the surgery could impact blinking rates and the natural tearing reflex and may take up to two years to recover.

Contact lenses

Dryness symptoms are reported in up to 77% of contact lens wearers and is most likely experienced at the end of the day. Dry eye may be caused by a disruption of the tear film, leading to reduced tear stability, increased evaporation rates and small changes in the tear composition.

Non-surgical procedures

Botulinum toxin is frequently used for patients with blepharospasm and hemifacial spasm, but also finds application in patients wishing to reduce wrinkles. Dryness symptoms due to botulin toxin have been reported in 19% of blepharospasm patients.

The use of cosmetics including facial creams and makeup can cause dry eye symptoms when migrating into the tear film or when accumulating inside the meibomian glands.

Tatooing of the eyelids or eyebrow/ eyelid piercings may impact meibomian gland function, which could reduce tear stability and cause dryness.

It is important to educate patients on potential dry eye side effects related to systemic and topical medications or treatments. The use of a preservative-free medications and lubricating eye drops is recommended in order to reduce dry eye symptoms. Ocular surgeries further carry the risk of temporary or permanent corneal nerve damage, which could result in dry eye, particularly in the elderly population with pre-existing dry eye disease.

REFERENCES

Gomes JAP, Azar DT, et al. TFOS DEWS II Iatrogenic report. Ocul Surf 2017;15(3): 511-538.

For further details, please refer to The TFOS DEWS II Iatrogenic report

Issues

  • Multifocal Contact Lenses
  • Artificial Tears: An Update
  • Myopia: New Evidence and Best Practices
  • Neuropathic Pain
  • Specialty Rigid Lenses
  • Contact lens compliance
  • Pandemic update
  • Digital Devices and Dry Eye: A Growing Issue
  • The long and short of axial length
  • Using BCLA CLEAR with your patients
  • Helping your patients through allergy season
  • Getting the measure of meibomian glands
  • 2020: An extraordinary year
  • Scleral lens update
  • A dose of myopia
  • New news since TFOS DEWS II
  • COVID-19 Special Edition
  • Material considerations
  • Putting dry eye theory into practice
  • Getting started with Ortho-K
  • Infiltrates – an update
  • Staining
  • Myopia matters: Summarising the IMI reports
  • Lids and contact lenses
  • Myths
  • Revisiting patient compliance
  • Contact Lenses & Kids
  • Interprofessional Collaboration
  • Digital eye strain
  • New Dry Eye Technology
  • Update on Presbyopia
  • Taking stock of dry eye disease: DEWS II
  • Scleral Lenses
  • Pain and Sensation
  • Lab measurements in clinical practice
  • Control of pediatric myopia
  • Nutrition
  • Rethinking contact lens deposits
  • Extended wear
  • Daily Disposables
  • Eyelash Mites (Demodex)
  • Outsmarting bacteria with new technology
  • Youth and contact lenses
  • Sports Vision
  • Ocular effects of UV radiation from the sun
  • Eyelid Conditions
  • Makeup: Impact on ocular health
  • Myopia Control – Update 2014
  • The Growing Prevalence of Myopia
  • Cosmetic contact lenses
  • Contact lens discomfort – The essentials
  • Technology and contact lens research
  • It's A Question of Comfort
  • Contact lens materials
  • Let's talk about SICS
  • Conjunctival Controversies
  • Kids & Contact Lenses
  • One-day silicone hydrogel lenses
  • Solutions
  • Spotlight on Scleral lenses
  • Drug delivery via contact lenses
  • Ocular allergies
  • Reducing lens case contamination
  • Dry eye and meibomium gland dysfunction
  • Myopia Control
  • Presbyopia
  • Compliance and non-compliance
  • Lens care
  • Celebrating 50 years of contact lenses

Looking for another article?

Alcon coopervision Johnson&Johnson Vision Care

Newsletter Sign-Up

Sign-up for and start receiving our newsletter.

Site Map

  • Home
  • Browse Past Issues
    • Editorial
    • Feature Article
    • Clinical Insight
    • Conference Highlights
  • Resource Library
  • Back to Basics
  • Useful Links
  • About Us
  • Contact Us
© 2023 Contact Lens Update