OTC Drugs & Eye Health: Risks & Awareness
- MINNEAPOLIS — Over-the-counter medications can have easily overlooked impacts on eye health if not used appropriately, according to a speaker at Optometry’s Meeting.
- “Many patients will come in having issues with their near vision, and it’s attributed to the digital age, age-related changes and, of course, environmental changes,” Dharmendra j.
- “The number of patients that are using over-the-counter medications chronically is actually shockingly high,” he said, suggesting that, in some cases, that could be “what’s interfering with their...
Key takeaways:
- Misuse of over-the-counter anticholinergics, antihistamines and decongestants is an easily overlooked eye health risk factor.
- Optometrists should ask patients about their use of over-the-counter drugs.
MINNEAPOLIS — Over-the-counter medications can have easily overlooked impacts on eye health if not used appropriately, according to a speaker at Optometry’s Meeting.
“Many patients will come in having issues with their near vision, and it’s attributed to the digital age, age-related changes and, of course, environmental changes,” Dharmendra j. bhoola, developmental behavioral optometrist at Vision Solutions in South Africa, said. “We always ask the question what chronic medications are you on, but we’ve never asked if you are taking any over-the-counter medications.
Over-the-counter medications can affect accommodation and induce dry eye. Image: Adobe Stock
“The number of patients that are using over-the-counter medications chronically is actually shockingly high,” he said, suggesting that, in some cases, that could be “what’s interfering with their vision.”
He used a bottle of cough syrup as a particular example.
“[The cough syrup] blocks activity of the sphincter muscle and the ciliary muscle of the lens, affecting accommodation, but if we look at the label, it says 12-hour cough relief,” he said. “It is a temporary relief, and it does say on the insert to discontinue after 3 days if symptoms persist. This is where a lot of the issues are, in that we are not following instructions by the pharmaceutical corporations that are manufacturing these drugs.”
Bhoola explained the ocular effects associated with misuse of three classes of over-the-counter drugs: anticholinergics, antihistamines and decongestants.
Anticholinergic medications inhibit the neurotransmitter acetylcholine, “which is critical for near vision,” he said.
“[Anticholinergic drugs] basically will inhibit the constriction of the pupil and the action of the ciliary muscles,” he said.
Decongestants are also anticholinergic in nature, Bhoola said.
“Patients need to be aware of it,” he said. “With viruses and stuff becoming more and more virulent, we find that people are relying more and more on self-medication and don’t realize the damage that it does.”
Antihistamines, which are often used for allergies, can “contribute critically to dry eye“Bhoola said.
“The anticholinergic activity of antihistamines will also drastically reduce the production of tears, triggering off an aqueous-deficient dry eye,” he said. “You can have dry eye, disruption to the osmolarity of the tear film, because the salts and chemicals in the tear film are now concentrated with the reduction of tear production.”
Bhoola said that, as “first port of entry” for people having near vision issues, optometrists should bear in mind the possible role of over-the-counter medications.
“In our protocol, we actually need to find out what over-the-counter medications they are using, how often and how long they’ve been on these drugs,” he said.
Patient education is also an important component, he added.
“They need to look at the labels: what a contraindication means, what a precaution means, what interaction means with other medications or chronic meds that they may be on, and what the adverse reactions are,” he said.
Sources/Disclosures
Collapse
Bhoola DJ. Over-the-counter medications: The good, bad and ugly. Presented at: Optometry’s Meeting; June 25-28, 2025; Minneapolis.
Disclosures:
Bhoola reports no relevant financial disclosures.