Do Eye Drops Cause Ringing In The Ears & Can Ringing In The Ears Mean Eye Problems?
Some online dry eye sufferers had recently asked if tinnitus (ringing in the ears) or hearing damage might be caused by Restasis (or other Cyclosporine eye drops commonly prescribed for dry eye) as the oral form of that medication has this listed as a risk factor. I decided to answer this to the best of my knowledge (the short answer is: I don’t think so – but the longer answer – along with some of my other clinical notes about Cyclosporine and an interesting association of tinnitus and another eye disease – follows.
Can Cyclosporine (Restasis, Cequa and many other iterations) cause hearing loss or ringing in the ears? While you have a Eustachian tube connecting your middle ear with the back of your throat, and a tear duct that connects your ear to the nose, I don’t believe Cyclosporine is likely to get to your ears from your eyes. Large studies under the watch of the FDA, and subsequent post-approval reporting have not listed ototoxicity (hearing/ear damage), so I see this as an additional measure of safety. The oral form of Cyclosporine can have many side effects but in the topical eye preparation, studies appear to confirm that it doesn’t get absorbed into the bloodstream, so I doubt Restasis, Cequa or the increasing iterations would cause hearing damage. Studies by Dr. Esen Akpek at Johns Hopkins’ Wilmer Eye Center: (https://www.researchgate.net/publication/291389788_Frequent_Dosing_of_Topical_Cyclosporine_A_for_Severe_Ocular_Surface_Disease) followed patients using it up to 8 times a day and their laboratory technology could not find it in their blood. Due to diversity of biology and degrees of sensitivity to medications, it is important to work with your doctors to ensure getting the best care for your health.
Interestingly, while tinnitus (ringing in the ears) is a relatively common condition, there has been a recent, small study, suggestions that it may be linked with Primary Open Angle Glaucoma (POAG, the most common kind of glaucoma). Glaucoma can lead to permanent loss of vision, so if you have tinnitus, you may wish to get checked for glaucoma, as this study found almost a 20% increased incidence of tinnitus in POAG patients: Associations between tinnitus and glaucoma suggest a common mechanism: A clinical and population-based study https://pubmed.ncbi.nlm.nih.gov/31841861/
Can you use Restasis more than twice a day? While every patient is different, the common thing about Cyclosporine is that it is (on purpose) a very weak anti-inflammatory drop. Depending on the amount of inflammation, using a weak drop twice a day may be enough - or not enough - to turn back the tide of inflammation. Meeting the amount of inflammation with the right amount of anti-inflammation, is key to overcoming the inflammation-related damage it inflicts on the ocular surface (& on the delicate tear system that is a part of that surface). Better, is to determine the cause of the inflammation and stop or reduce it so that less (or no) medication is required. The short answer is that many of my patients end up using Restasis more than twice a day. The ideal frequency will depend on the patient’s (often many) issue’s driving their dry eye disease and the goal is to reduce inflammation to the degree where less (or no) anti-inflammatory medication is required over time. Rarely do I prescribe it more than 4x/d for extended periods of time (though some do require an arsenal of anti-inflammatory products to get their eyes back to good health). As usual, consult your dry eye specialist for what is best for you.
Why does Restasis (Cequa and other Cyclosporines) sting and burn so much? Does this mean I am allergic to it or otherwise shouldn’t use it? Evaporation and dryness lead to “dry spots” (& damage) on the cornea. Corneas have more pain fibers per square inch than any other part of your body, so these dry spots can register more pain - like tiny open sores. Cyclosporine medications like Restasis are a “salty drop,” so when eyes are very dry, this can be like rubbing salt into your eye’s open sores. Fortunately, the more it works - the more you can make better tears and have a healthier cornea - and Restasis can be less uncomfortable. Once you stop Restasis it doesn’t take long for its benefits to wear off. Sadly, it can then take months for it to kick in again. Keeping these drops in the refrigerator and using them straight out of the fridge means the coolness of the drop can be more soothing than burning. Using a preservative free artificial tear 5 to 10 minutes before applying the medicated drop will often moisten and lubricate the otherwise raw surface, so there are fewer “open sores” when the salty medication is applied – and better tolerated. If eyes (and eyelids) become red and itchy while using these drops, it is possible you are developing an allergy – though eyes can become red and itchy for many reasons unrelated to medication allergies – so best to consult your dry eye specialist. An exam of the membranes under the lids and a careful history of how the problem came on, can often help sort out the cause. Sometimes more specific allergy testing is required, and it may be necessary to stop all products that come in contact with your eyes and eyelids – and then selectively adding them back one at a time over days to weeks – in order to best determine the offending cause(s).
To schedule an appointment with Dr. Jaccoma, call Excellent Vision at either of these two dry eye offices:
(1) 155 Griffin Rd, Portsmouth, NH 03801 (603) 574-2020
(2) 3 Woodland Rd, STE 112 Stoneham, MA 02180 (near Boston) (781) 321-6463