Glucagon-like peptide-1 (GLP-1) agonists have become a common sight on patient history forms. In fact, in a large survey taken last year, 12% of American adults said they have used a GLP-1 drug. That number jumped to 43% among diabetics, followed by those with heart disease (26%) and people seeking weight loss (22%) (1).
This is potentially great news for patients with dry eye disease (DED). Amelioration of obesity, diabetes, and systemic inflammation with GLP-1 agonists suggests an indirect positive effect on the ocular surface. However, the systemic side effect profile of these biologics shows potential to aggravate DED and negate ocular surface improvement. There is a dearth of literature specifically tackling the prevalence of DED before and during GLP-1 therapy, so in the absence of definitive prospective, randomized clinical trials, both eye care providers and GLP-1 prescribers should be aware of potential DED complications and how to ensure patients can experience all the benefits of these groundbreaking drugs without compromising ocular health.
Patients with diabetes
The GLP-1 mechanism for improving blood glucose and helping patients lose weight also has the potential to improve ocular disease, with some caveats. For diabetic patients, the benefits of managing diabetes are well understood, including reduction of risks associated with diabetic eye disease. If a patient is no longer severely diabetic and they have normal glucose metabolism, the nerves in the cornea improve. Ocular surface inflammation decreases as inflammation is controlled throughout the body. My diabetic patients typically have significant ocular surface disease, so I’m hopeful that managing diabetes with GLP-1 therapy will promote improvement.
Importantly, new clinical evidence has shown that diabetic patients taking GLP-1 agonists are less likely to develop DED because of the anti-inflammatory effects on the lacrimal glands (2). It’s worth noting that GLP-1s have also been shown to lower glaucoma risk in patients with diabetes (3), in turn theoretically decreasing the need for topical glaucoma medications that can disturb the ocular surface. At the same time, we need to be aware that GLP-1s appear to elevate the risk of age-related macular degeneration (AMD) in patients with diabetes (4).
Dehydration potential
For patients using GLP-1s to manage diabetes or lose weight, there is reason for concern that use of GLP-1s may diminish the hydration patients need to maintain a healthy ocular surface. GLP-1s can interfere with natural hunger and thirst cues, as well as causing side-effects like nausea, vomiting, and diarrhea.
Patients who are taking GLP-1s for weight loss have the added risk of becoming deficient in nutrients that are needed for the health and integrity of the ocular surface, such as antioxidants, trace minerals, and vitamins D and C. It’s therefore important to remind busy patients using GLP-1s of the importance of hydration and maintaining a nutritious diet.
Treating DED in patients taking GLP-1s
Although GLP-1s are relatively new, we’ve had a few years to adjust to their prevalence.My first piece of advice for cataract patients is to have surgical schedulers take extra care to remind them both verbally and in writing to temporarily discontinue their GLP-1s one week before surgery. We’re seeing a small but significant cancellation rate because people forget to stop taking them. GLP-1s are generally stopped before surgery because they delay stomach emptying, which increases the risk of regurgitation and aspiration during anesthesia. This precautionary measure protects patients from potentially serious complications, including aspiration pneumonia. I also suggest the following approach to treating DED in patients taking GLP-1s:
Long-term management – I always let patients know that by taking a positive approach to preventive self-care by controlling their A1C, losing weight, and following a healthier diet with a GLP-1, they’re also helping their eyes. A few simple steps can help them further improve their ocular health and manage DED symptoms. More severe cases can require additional therapies, such as prescription medications, but these therapies are the basis for all cases of DED:
Nutritional supplement – Nutritional supplements made specifically for DED, such as HydroEye (ScienceBased Health), De3 Omega Benefits (PRN), or Blink (Bausch & Lomb), can improve the tear film and the ocular surface from the inside out.
Lubricant – A high-quality, preservative-free artificial tear helps patients keep the ocular surface well-lubricated. My current choice is iVIZIA (Thea), which has sustained retention on the eye and offers excellent lubrication. It comes in a proprietary multidose bottle that’s quite easy to use, even for my older patients.
Heat mask – Most DED patients have meibomian gland dysfunction, so I ask them to use a heat mask followed by a lid scrub once a day to thin the meibum and improve stability of the tear film.
Hydration – “Drink plenty of water” is good advice, but I like to offer more specific, practical advice to patients taking GLP-1s. I suggest that they maintain a regular daily hydration routine that makes it easy to track fluid intake and lets them know they’re succeeding. Dietary changes can help as well, such as reducing salty and spicy foods, snacking on high-water foods like melon and berries, and increasing electrolyte intake, especially in the morning.
Nutrition and lifestyle – Although GLP-1 agonists are a promising class of medications, they aren’t a cure-all. Doctors who prescribe them educate patients about the importance of healthy habits like following a nutritious diet, getting regular exercise, and smoking cessation. I always reinforce these educational points by talking to these patients about lifestyle. I ask what they’re eating and stress the value of fruits, vegetables, nuts, and seafood. I remind them that any increase in exercise is good and can help control A1C and weight—and improve the health of their eyes.
Looking ahead
In the last few years, I’ve seen most of my patients on GLP-1s lose weight and lower their A1C, which has improved their general health and outlook on life. Diabetic control and healthy weight are beneficial for most chronic ocular diseases, including glaucoma, macular degeneration, and DED, as long as we help ensure that patients using GLP-1s achieve those goals by incorporating hydration and good nutrition.
References
- A Montero et al., KFF health tracking poll May 2024: the public’s use and views of GLP-1 drugs. May 10, 2024. Accessed August 25, 2025. https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-may-2024-the-publics-use-and-views-of-glp-1-drugs/
- YC Fan et al., "The Utilization of Glucagon-like Peptide 1 Agonists and Risk of Following External Eye Diseases in Type 2 Diabetes Mellitus Individuals: A Population-Based Study," Healthcare (Basel), 11, 2749 (2023). PMID: 37893823.
- M Asif et al., "Incidence of Glaucoma in Type 2 Diabetes Patients Treated With GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis," Endocrinol Diabetes Metab., 8:e70059 (2025). PMID: 40509955.
- R Shor et al., "Glucagon-Like Peptide-1 Receptor Agonists and Risk of Neovascular Age-Related Macular Degeneration.," JAMA Ophthalmol., 143, 587 (2025). PMID: 40471562.
