Does Duloxetine cause dry eyes? (3+ tips)

In this article, we will discuss if duloxetine causes dry eyes. We will talk about the research findings along with factors which can contribute to dry eyes and some tips for managing dry eyes.  

Does Duloxetine cause dry eyes? 

Yes, Duloxetine can cause dry eyes, but the occurrence of this is very rare. The medication guide for duloxetine mentions eye-related side effects such as blurred vision, diplopia and visual disturbance occurring in at least 1/1000 people (1)

Dry eyes caused by duloxetine are a very rare side effect and depend on the individual’s response to the medication. Dry eyes can present with a stinging, burning, itching sensation, watery eyes or a feeling of pressure in the eye. These symptoms can occur at the beginning of the treatment with the drug, which eventually subsides as your body gets used to the drug. (2)

There are other factors that can contribute to dry eyes, so make sure you identify the cause before treating it. If you are experiecning any side effects after taking duloxetine, visit your physician for further management and avoid discontinuing your medication abruptly. 

What does the research suggest?

The antidepressant class selective serotonin reuptake inhibitor (SSRI) and serotonin-norepinephrine reuptake inhibitor (SNRI) have an increased risk of causing dry eyes. (3) There are research studies which suggest that individuals who are suffering from anxiety and depression are more likely to have dry eye problems. (4)

A research study was done by Isik-Ulusoy et al. about the influence of antidepressants on the ocular surface in which 132 patients were being treated with different antidepressants, namely venlafaxine (32), duloxetine (28), escitalopram (28) and sertraline (34), the duloxetine-treated group had the lowest tear parameters and  Schirmer test. The Schirmer test determines if the eye produces sufficient tears to keep it moist. (5)

The study found that SSRIs and SNRIs affect the ocular surface due to their anticholinergic action. The study also noted that SNRIs can have an impact on dry eye due to their effect on noradrenaline and serotonin. (5)

What are the other eye-related side effects caused by duloxetine? 

Duloxetine is an antidepressant which belongs to the class of serotonin-norepinephrine reuptake inhibitors (SNRI), which increases the level of serotonin, norepinephrine and, to some extent, dopamine by inhibiting the reuptake transporters of these neurotransmitters. (2)

Duloxetine has been reported to cause other eye-related side effects, such as blurred vision, diplopia and visual disturbance. The eye-related side effects caused by SNRIs are rare and occur in very few individuals. 

A 44-year-old female experienced unilateral vision loss due to optic neuritis after starting her treatment with duloxetine. Similarly, an 81-year-old woman reported a bilateral acute angle closure glaucoma (sudden increase in intraocular pressure) after taking duloxetine for two days. (6), (7)

In another case report, a 24-year-old female patient who was being treated with duloxetine for her depression experienced cycloplegia (paralysis of the ciliary muscle in the eye). (8)

What are the factors that can contribute to duloxetine-induced dry eyes? 

In addition to duloxetine, there are other factors that can lead to dry eyes, such as: 

Anticholinergic medications: Drugs that have anticholinergic effects can affect tear production in the eyes, resulting in dry eyes. Drugs such as antipsychotics, tricyclic antidepressants, diphenhydramine, etc. 

Individual sensitivity: Some individuals may be more sensitive to duloxetine. The effect of duloxetine varies from person to person. Individuals who are more sensitive to the drug may experience dry eyes along with the other side effects of duloxetine. 

Dehydration: Dehydration can reduce water levels in your body, which can indirectly contribute to dry eyes. 

Concomitant medication: Taking other medication concomitantly, which can increase the concentration of duloxetine, can increase the risk of side effects. 

Underlying conditions: Pre-existing conditions such as Sjogren’s syndrome (an autoimmune disease which degenerates salivary and lachrymal glands, causing dryness), allergic eye disease, rheumatoid arthritis, hormonal changes, vitamin deficiency, etc, can lead to dryness of eyes. 

Meibomian gland dysfunction (MGD): Dysfunction of MGD can result in ocular surface disease, discomfort in the eye and dry eyes. Meibomian glands secrete meibum, an oily substance that covers the aqueous layer of the eye and protects it from dryness. (9)

Inflammation of the eyelid: This can affect the oil glands present in the eyelid, which produces tears, causing dry eyes. 

Environmental factors: Exposure to dry, cold or windy climates can contribute to dryness of the eyes. 

Others: Some allergic reactions, wearing contact lenses for a long period, and prolonged use of digital devices can also contribute to dry eyes. 

What are the alternatives if duloxetine causes dry eyes? 

If duloxetine is causing discomfort, you have the option to switch to other antidepressants. Some alternatives include:

• SSRI: fluoxetine, sertraline, paroxetine, escitalopram, citalopram.
• SNRI: venlafaxine, desvenlafaxine, milnacipran.
• Tricyclic antidepressants: amitriptyline, imipramine, nortriptyline.
• Atypical antidepressants: bupropion, mirtazapine, trazodone. 

Remember, selecting a drug while switching antidepressants should be done by a qualified physician. Consult your physician for proper management of your side effects. 

What to do if duloxetine causes dry eyes? 

Here are some tips to manage dry eyes. 

• Get yourself evaluated for any underlying causes of dry eyes.
• You can use OTC artificial tears to lubricate your eyes, which will help you with dryness in the eye.
• Stay hydrated and drink an adequate amount of water every day. 
• Maintain a healthy diet with proper nutrients, as nutrient deficiency can contribute to dryness of the eye. 
• Use a humidifier if the indoor environment is dry.  
• While using any digital gadgets, take frequent breaks to avoid straining of eyes. 
• If duloxetine is causing dryness of the eye, you can shift to other antidepressants with fewer side effects and which suits you best. 
• Be aware of the side effects of duloxetine, such as insomnia, dry mouth, dizziness, tremors, agitation, nausea, vomiting, etc. 
• Minimising the dose of the drug and switching to another antidepressant should be done by a certified physician. 
• Consult your physician if you are experiencing any side effects after taking duloxetine. Do not discontinue taking duloxetine because of the side effects, as it can cause withdrawal symptoms and worsen your condition.

In my opinion, duloxetine can cause dry eyes, but the occurrence of this is very rare. If dry eyes are affecting your day-to-day activities, I would recommend you consult your physician for proper management. 

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