Benzodiazepine-Associated Dry Eye Disease
Introduction to Benzodiazepine-Associated Dry Eye
- The American Academy of Ophthalmology identifies antianxiety medications, including benzodiazepines, as a risk factor for dry eye disease, based on the Beaver Dam Eye Study update 1.
- Antidepressant and antianxiety medications, including benzodiazepines, are identified as risk factors for dry eye in population-based studies, according to the American Academy of Ophthalmology 2, 3.
Mechanisms and Risk Factors
- Benzodiazepines contribute to dry eye through anticholinergic effects, disrupting the efferent cholinergic nerves responsible for stimulating tear secretion, as reported by the American Academy of Ophthalmology 4, 3.
- Sedative-hypnotic medications, including benzodiazepines, may be associated with dry eye development in patients with sleep disorders, according to a Chinese study cited by the American Academy of Ophthalmology 1.
Clinical Significance and Management
- The American Academy of Ophthalmology recommends confirming the diagnosis of dry eye in patients on benzodiazepines by looking for fluctuating vision, ocular irritation symptoms worse at the end of the day, and punctate epithelial erosions on dye staining 4, 5.
- The American Academy of Ophthalmology suggests assessing the severity of dry eye by evaluating for moderate-to-severe pain, corneal infiltration/ulceration, or progressive conjunctival scarring that would require ophthalmology referral 6.
- Patients on benzodiazepines often take other medications that worsen dry eye, creating an additive effect, as noted by the American Academy of Ophthalmology 2, 4, 8.
- The American Academy of Ophthalmology advises that preserved eye drops can paradoxically worsen symptoms through corneal epithelial breakdown if used more than 4 drops daily 2, 4, 8.