Antidepressants Linked to Goblet Cell Loss, Dry Eye Damage

Psychiatric disorders such as depression have been linked to dry eye disease; however, a recent study strengthened the association between worsening dry eye signs and antidepressants—prescription medications used to treat depression. Photo: Paul M. Karpecki, OD. Click image to enlarge. A recent study found that antidepressant use was associated with goblet cell loss, conjunctival epithelial damage and worse dry eye signs, with the findings applicable to all classes of antidepressants.Researchers evaluated 142 adults ages 20 to 40, with 72 antidepressant-taking patients and 70 age- and sex-matched controls. Participants using antidepressants—specifically selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) or tricyclic antidepressants (TCAs)—completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent tear breakup time (TBUT), Schirmer testing, corneal and conjunctival staining, slit lamp examination and conjunctival impression cytology. It was noted in the paper that the “majority of the participants were taking SSRIs (75%), followed by SNRIs (11.1%) and TCAs (13.9%).”The authors measured goblet cell density and conjunctival epithelial changes, including nuclear-cytoplasmic fraction, cell-to-cell contact and nuclear abnormalities.The antidepressant group was found to have significantly lower goblet cell density than controls (183 vs. 366 cells/mm²), lower TBUT (6.7 seconds vs. 10.8 seconds), lower Schirmer scores (5.8 vs. 7.6mm/5min) and lower nuclear-cytoplasmic fraction, while reporting higher OSDI symptom scores. They were also more likely to have corneal staining (odds ratio [OR]: 13.0), reduced goblet cell density (OR: 9.3) and abnormal TBUT (OR: 7.0). Goblet cell density correlated positively with TBUT (r=0.41) and Schirmer test results (r=0.43), suggesting that mucin-producing goblet cell loss contributed to tear film instability.Aside from slightly worse corneal and conjunctival staining outcomes among the TCA group, “no significant differences” were found “in ocular surface parameters among SSRIs, SNRIs and TCAs.” Antidepressant use, lower TBUT and lower Schirmer scores were analyzed and all found to be independent predictors of reduced goblet cell density, while symptom scores, age and ocular staining were not.“Antidepressant therapy is associated with significant ocular surface alterations,” wrote the authors, “including reduced goblet cell density, epithelial damage and decreased tear stability.” They concluded that patients taking antidepressants should receive routine ocular surface evaluations to detect dry eye changes early and guide management.Click here for the journal source. Chotaliya R, Mishra N, Prasad N, et al. Conjunctival goblet and epithelial cell changes in antidepressant-associated dry eye disease: a case-control study. BMC Ophthalmol. June 18, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.