Antihypertensive Eyedrops Trigger Dry Eye Disease, Corneal Damage

Patients with primary open-angle glaucoma treated with topical antihypertensive drugs have weakened tear function and greater dry eye disease symptoms.

Antihypertensive eyedrops can lower intraocular pressure (IOP), but likely instigate or worsen dry eye disease (DED) symptoms and parameters of corneal damage, according to a report published in the Journal of Glaucoma. Investigators measured ocular surface characteristics in a cohort taking topical antihypertensives eyedrops and compared test results with healthy individuals, reporting significant changes in case eyes for nearly all parameters.

The cross-sectional study evaluated 154 eyes of 154 participants (77 patients with primary open-angle glaucoma [POAG]; mean age, 70.6±12.3 years), who visited a tertiary center’s glaucoma clinic between October 2020 to April 2021, and 77 sex- and age-matched individuals from a general ophthalmology clinic.

Researchers performed assessments using Schirmer testing, the Ocular Surface Disease Index (OSDI), and automated ocular surface analysis.

The investigators report that all the patients who used antihypertensive eyedrops for longer than 4 years had weaker surface function than patients in the control group. The proportion of patients meeting the Tear Film and Ocular Surface Society’s criteria for
DED was higher among the group who used drops to lower IOP than among those who did not (57.1% vs 15.6%, P <.001). The case group also had more participants complain of itching (48.1%) stinging (37.7%), gritty sensations (27.3%) and tearing (24.5%).

To minimize the negative effects of ocular surface changes, it is fundamental that clinicians evaluate and address the DED in patients with glaucoma.

The patients who used antihypertensive eyedrops also had higher parameters compared with the participants in the control group regarding:

• Loss of meibomian gland (MG) area (16% vs 9%; P =.004).
• Tear film osmolarity (314 vs 306 mOsm/L; P =.003).
• OSDI score (19 vs 4; P <.001).
• Lipid layer thickness (69±26 vs 80±24; P =.006).
• Non-invasive tear break-up time (9.9±2.5 vs 11.0±2.7 seconds; P =.005).
• Tear meniscus height (0.23 vs 0.30 mm; P =.001).

No significant association arose between use of antihypertensive eyedrops with or without preservatives, or among OSDI scores and duration of drop use.

“To minimize the negative effects of ocular surface changes, it is fundamental that clinicians evaluate and address the DED in patients with glaucoma,” according to the investigators.

Prior studies on the effect of antihypertensive eyedrops have also found signals such as greater corneal staining, MG area loss, and higher OSDI. In other research, patients undergoing drop therapy attained comparable OSDI scores to individuals who had glaucoma surgery and no antihypertensive eyedrops for 1 year or longer — although surgery may impair surface health via alternate processes.

This analysis was limited by a control set that may not represent the general population, absence of eyes with glaucoma treated without antihypertensive eyedrops, and OSDI responses swayed by glaucoma severity.


Castro C, Marta A, Marques JH, et al. Ocular surface changes in primary open-angle glaucoma patients treated with topical antihypertensive drugs. J Glaucoma. July 21, 2023. doi:10.1097/IJG.0000000000002272