Overactive Bladder Medications and Dry Eye: What Eye Doctors Need to Know

Quick Summary:
Millions of people take medications for overactive bladder (OAB), most of which fall into a drug class known as anticholinergics. These drugs are effective for bladder symptoms—but they often come with side effects that affect the eyes, especially dry eye. In this article, we’ll break down why OAB medications can lead to dry eye, which drugs are most likely to cause it, and what you can do to help your patients manage the symptoms.

Why This Matters in the Exam Room

The market for OAB drugs is growing quickly and is expected to surpass $5 billion by 2030. That means more and more of your patients are showing up on anticholinergic medications, even if they don’t volunteer that information right away.

Eye care professionals need to recognize the connection. These medications don’t always list dry eye as a primary side effect, but they do have a real impact on the tear film. If a patient is on one of these drugs and complaining about burning, blurry, or gritty eyes, it’s time to take a closer look.

Common Overactive Bladder Medications to Know

The most commonly prescribed OAB medications are anticholinergics, which block a neurotransmitter called acetylcholine to reduce muscle spasms in the bladder. Unfortunately, these same receptors are also involved in tear production and ocular surface health.

Here are the most commonly prescribed OAB medications you’re likely to see:

They may come in tablets, patches (like Oxytrol), or topical forms.

How These Medications Contribute to Dry Eye

The tear film depends on a balance of water, oil, and mucin to keep the eyes comfortable and protected. Anticholinergic drugs affect all three components.

1. Reduced Tear and Mucin Production

By blocking muscarinic M3 receptors, these drugs:

• Suppress the lacrimal gland, reducing aqueous tear secretion
  
• Inhibit goblet cells in the conjunctiva, which lowers mucin levels needed for tear stability
  
  

2. Meibomian Gland Dysfunction

The meibomian glands produce the oil layer of the tear film. While anticholinergics don’t block these glands directly, they:

• Disrupt the neurologic input needed for proper oil secretion
  
• Contribute to gland stagnation and dropout over time
  
• Worsen with age, screen use, or poor blink quality
  

The result is often mixed-type dry eye: both evaporative and aqueous-deficient. These cases are harder to manage and usually more symptomatic.

How Common Is Dry Eye With These Drugs?

Dry eye is often underreported in clinical trials, but the evidence is growing:

• Anticholinergic load is a known risk factor for dry eye
  
• The more anticholinergics a patient is on, the higher the risk
  
• A 2021 study in Ophthalmology found that patients taking multiple anticholinergics had significantly higher dry eye scores
  
• Post-market reports have flagged oxybutynin, tolterodine, and darifenacin as frequent culprits for dry eye symptoms
  

In short, dry eye is more common in these patients than most clinicians realize.

What to Do If a Patient on OAB Medications Has Dry Eye

1. Don’t Recommend Stopping the Medication Without Coordination

These medications are prescribed for good reason, often to improve quality of life or avoid surgery. If dry eye becomes a problem, work with the prescribing physician. Some patients may be able to switch to mirabegron, a beta-3 agonist that doesn’t affect tear production in the same way.

2. Start a Dry Eye Routine Right Away

Patients don’t need to wait for severe symptoms. If they’re taking OAB medications and experiencing any dryness, get them started with these steps:

A. Preservative-Free Artificial Tears

Recommend using lubricating drops three to four times a day. Look for formulas that are lipid-based or designed for evaporative dry eye. Peeq Pro’s preservative-free drops are one option, especially for contact lens users.

B. Warm Compresses and Lid Hygiene

Daily warm compresses help keep oil glands flowing. Use a heated eye mask and follow with a gentle cleanser like Peeq Pro’s hypochlorous spray or tea tree-based lid wipes.

C. Omega-3 Supplements

Omega-3s (at a dose of 2000mg/day) may help reduce inflammation and improve meibomian gland function over time.

D. Environmental Support

Humidifiers, blue light filters, and regular screen breaks can make a noticeable difference for patients working in dry or digital environments.

3. Schedule a Comprehensive Dry Eye Evaluation

If symptoms persist, evaluate:

• Tear breakup time
  
• Meibomian gland health with meibography
  
• Staining patterns
  
• Tear volume
  

Depending on the severity, you may recommend:

• Prescription drops like cyclosporine (Restasis) or lifitegrast (Xiidra)
  
• In-office treatments like LipiFlow or IPL
  
• Punctal plugs for aqueous-deficient cases
  
  

FAQs: OAB Medications and Dry Eye

Q: Is dry eye listed as a side effect on the drug label?
A: Sometimes, but not always. Many of these medications don’t mention dry eye directly, but their anticholinergic activity makes it a likely side effect, especially in long-term users.

Q: Are certain patients more at risk than others?
A: Yes. Women, older adults, contact lens users, and those on multiple medications are more likely to develop symptoms. Screen use and low humidity environments also contribute.

Q: What’s the alternative if a patient can’t tolerate the dry eye side effects?
A: Mirabegron (Myrbetriq) is one potential alternative. It works differently and doesn’t interfere with tear production in the same way.

Final Thoughts for Eye Care Professionals

OAB medications don’t get talked about much during eye exams, but they should. If a patient is taking one of these drugs and complains of dryness, burning, or fluctuating vision, don’t assume it’s just aging or screen use. The medication may be playing a significant role.

Ask about comfort, not just vision. Recognize the drug names. Help the patient manage symptoms early—before gland dysfunction becomes more difficult to reverse.

At Peeq Pro, we offer easy-to-follow treatment bundles and clinic support tools to help you manage medication-induced dry eye in a way that’s both effective and simple to implement.