Tricyclic antidepressants (TCAs) – especially amitriptyline, imipramine, and doxepin – are one of many drugs that are linked to dry eye. Not every TCA has as high of a risk factor of causing or worsening dry eye, but there are many out there that are particularly well-known to cause dry eye.
Three TCAs with the highest risk of leading to dry eye are amitriptyline, imipramine, and doxepin. TCAs are commonly used to treat depression, OCD, anxiety, and other disorders. They work by blocking the actions of certain neurotransmitters in the brain including serotonin, norepinephrine, and acetylcholine.
Acetylcholine is a neurotransmitter that’s crucial to part of your autonomic nervous system (your body’s automatic functions). Muscarinic receptors are one type of receptor that receives this acetylcholine. These receptors control glands like the lacrimal glands, which produce tears.
When these processes are blocked by TCAs, your lacrimal glands produce fewer tears, leaving the surface of the eyes dry, irritated, and more vulnerable to inflammation and damage – leading to dry eye symptoms.
Amitriptyline ranks among the top prescribed TCAs; it was the 87th most common medication in the U.S. in 2022, with over 7 million prescriptions 1. Its strong anticholinergic activity means dry eyes are a common side effect, along with dry mouth, blurred vision, etc.
Why Women Are at a Greater Risk for Dry Eye on Amitriptyline
Research suggests that women are significantly more likely to experience dry eye as a side effect of amitriptyline. In fact, a World Health Organization review showed 92% of reported cases of dry eye linked to the drug were in female patients. The exact reason for this isn’t known, hormonal differences may play a role.
Women are more prone to dry eye in general, especially after age 40 due to estrogen and hormone changes associated with menopause. Adding a TCA like amitriptyline to the mix can further interfere with tear production and exacerbate the symptoms dramatically.
It’s important that women, especially those already experiencing dry eye symptoms, should be extra cautious in managing their dry eye when taking medications like this.
Managing Dry Eye from Tricyclic Antidepressants
If you’re experiencing dry eyes while taking a tricyclic antidepressant like amitriptyline, you’re not alone. The good news is, there are several simple ways to manage it. Here are 5 effective strategies that can help soothe and protect your eyes:
1. Gentle Eyelid Cleaning - Peeqing your Eyelids
- Daily eyelid cleansing can help remove debris, oils, and bacteria that clog the tear glands and make symptoms worse
- Use a gentle, tea tree oil based lid cleanser (we recommend Peeq's Foaming Eyelid and Facial Cleanser) or hypochlorous acid spray (e.g., Optase Protect Spray, TTO Wipes, or Pure&Clean HOCl products) to clean along the lash line
- Even a simple routine like this can make a big difference in reducing irritation and improving tear quality
2. Use Lubricating Eye Drops (Artificial Tears)
- One of the easiest eye moistening habits to add to your routine
- Use preservative-free versions if you’re using them more than a few times a day, to avoid added irritation
3. Use a Warm Compress (e.g., Peeq Pro Warm Compress)
- Heat promotes meibomian gland function helps open clogged oil glands and improve tear film stability
- Apply a warm compress (40°C or ~105°F) over closed eyes for 5-10 minutes followed by a gentle lid massage
4. Try Omega-3 Supplements (e.g., MacuHealth TG Omega 3 Fish Oil)
- Omega-3s help improve tear quality and reduce eye inflammation by supporting the oily layer of the tear film and calming surface irritation
- It’s suggested to take 2,000 mg of combined EPA and DHA daily
5. Environmental and Behavioral Adjustments
- Small changes in your daily habits and surroundings can make a big difference when managing dry eye:
- Drink plenty of water – aim for at least 11.5 cups (2.7 L) a day to stay fully hydrated
- Use a humidifier at home or work to add moisture to dry indoor air and prevent tear evaporation
- Avoid direct air flow from heaters, fans, or car vents, which can dry out your eyes quickly
- Take regular screen breaks to reduce eye strain and encourage more frequent blinking
Conclusion
Dry eye symptoms caused by tricyclic antidepressants like amitriptyline can be frustrating, especially when you're relying on these medications to manage serious conditions like depression or anxiety. While the side effects of these medications may feel discouraging, it’s important to remember that they’re manageable.
Adding daily eyelid cleansing, warm compresses, omega-3 supplements, and artificial tears to your daily routine can help alleviate dry eye symptoms and allow you to get back on track with living.
If dry eyes are interfering with your daily comfort or quality of life, don’t hesitate to take action. With the right care plan and consistent habits, it’s possible to keep your eyes comfortable while staying on track with your mental health goals.
Note: If dry eye continues to be persistent or severe, talk with your doctor about possibly lowering your dose or switching to another medication with fewer anticholinergic effects.