Finasteride and Dry Eye Disease: Is There A Connection?

Article Summary

Finasteride is a well-established treatment for hair loss, but some reports suggest it may contribute to dry eye disease. This article examines how finasteride’s hormonal effects may impact tear production, reviews current research findings, and provides practical steps for managing or preventing eye dryness during treatment.

Full Article

Finasteride is widely used for androgenic alopecia (AGA) and benign prostate hyperplasia (BPH). It’s generally well tolerated, with most users experiencing no significant adverse effects.   However, clinicians in eye clinics have reported occurrences of dry eye that could be related to the use of finasteride.^[1]NZ Optics. (2022). Finasteride and dry eye disease. Available at: https://www.nzoptics.co.nz/live-articles/finasteride-and-dry-eye-disease/ (Accessed: October 2025) 

Dry eye disease (DED) is a common eye disorder characterized by insufficient tear production or poor tear quality. This can cause inadequate lubrication of the eye’s surface, leading to discomfort, irritation, and potentially damage to the eye. The condition is multifactorial, meaning it can be caused by a number of different factors. One important cause is increased tear evaporation, leading to evaporative dry eye. The quality and structure of tears are regulated by hormonal pathways, meaning that the anti-androgenic activity of finasteride could drive the development of the condition.^[2]Golden, M. I., Meyer, J. J., Zeppieri, M., & Patel, B. C. (2024). Dry Eye Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available at: … Continue reading

In this article, we will examine the research that links finasteride to dry eye disease and explore the potential mechanisms by which it may be contributing to the condition. 

Finasteride and the Eye

Finasteride is a 5α-reductase inhibitor and works by reducing the conversion of testosterone to dihydrotestosterone (DHT). DHT drives the shrinking and weakening of hair follicles in AGA, meaning that finasteride activity can counteract these effects by decreasing the amount of DHT. Finasteride is typically administered orally, meaning it can have systemic effects on multiple parts of the body. This is particularly important in tissues that are sensitive to androgens like DHT.^[3]Zito, P. M., Bistas, K. G., Patel, P., & Syed, K. (2024). Finasteride. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available at: … Continue reading

The meibomian glands are one such tissue. They are special sebaceous (oil-producing) glands located within the upper and lower eyelids, with each eye containing 20 – 40 of these glands. They produce meibum, a lipid-rich secretion that forms the outermost layer of the tear film and plays a critical role in maintaining ocular surface health. With every blink, meibum is expressed from the gland orifices, forming a thin, uniform layer over the eye. Meibum’s main function is to prevent evaporation of the tear film by creating a stable oil barrier, ensuring long-lasting lubrication of the eye’s surface.^[5]Sabeti, S., Kheirkhah, A., Yin, J., & Dana, R. (2020). Management of meibomian gland dysfunction: a review. Survey of Ophthalmology. 65(2). 205-217. Available at: … Continue reading

Meibomian glands are directly regulated by androgens, via receptors present in their epithelial cells. Androgens, such as DHT, can bind to these receptors, directly influencing the synthesis of lipids essential for tear formation. Importantly, DHT is also synthesized in meibomian glands by 5α-reductase. This is where the connection to finasteride comes in: inhibition of 5α-reductase by the drug could stop DHT activity in the meibomian glands, stopping the production of lipids required to prevent tear evaporation. As such, while finasteride doesn’t target the eye, its impact on androgen pathways can have indirect effects.^[7]Traish, A. M. (2020). Health risks associated with long-term finasteride and dutasteride use: it’s time to sound the alarm. The World Journal of Men’s Health. 38(3). 323-337. Available at: … Continue reading

Even partial androgen suppression, like oral finasteride for hair, could be enough to impact tear production, particularly in someone who has other risk factors associated with DED, such as older age, prolonged screen time, certain medications (antihistamines, antidepressants, diuretics, beta-blockers), autoimmune or connective tissue diseases, and environmental exposures such as wind, dry climates, or smoke.

Do DHT-Reducing Therapies Lead to Dry Eye?

A role for androgens in regulating meibomian gland function was proposed in a paper published in 2000.^[8]Krenzer, K. L., Reza Dana, M., Ullman, M. D., Cermak, J. M., Tolls, D. B., Evans, J. E., & Sullivan, D. A. (2000). Effect of androgen deficiency on the human meibomian gland and ocular surface. … Continue reading Patients who were taking antiandrogen drugs for issues related to the prostate were assessed on symtpoms of DED and the contents of their meibomian gland secretions. They were compared to a control group that was on such medications. They found that antiandrogen therapy changes the composition of lipids in tears, while also decreasing the quality of tears and increasing participants’ susceptibility to light sensitivity, painful eyes, and blurred vision. This study laid the foundation for our current understanding of how DHT-lowering therapies might cause DED. 

Preclinical Data

Animal models have been developed to understand the mechanisms that lead to DED, including a potential role for DHT-lowering therapies as suggested by these clinical findings. A 2014 study utilized a rat model to investigate the impact of finasteride on tear production.^[9]Singh, S., Moksha, L., Sharma, N., Titiyal, J. S., Biswas, N. R., & Velpandian, T. (2014). Development and evaluation of animal models for sex steroid deficient dry eye. Journal of … Continue reading They found that oral administration of 1.6 mg/kg finasteride every day significantly decreased tear flow and increased the speed at which tears break up after 10 days in both male and female rats.

This study was supported by further research published in 2017, which used the same concentration of finasteride in rats for 40 days.^[10]Li, K., Zhang, C., Yang, Z., Wang, Y., & Si, H. (2017). Evaluation of a novel dry eye model induced by oral administration of finasteride. Molecular Medicine Reports. 16(6). 8763-8770. Available … Continue reading They also found that tear production was reduced in finasteride-treated rats, and makers for tear break-up were increased. The impact of finasteride on tear production in rats is so reliable that it has been used to induce DED in models investigating potential treatments for the condition.^[11]Zhang, C., Li, K., Yang, Z., Wang, Y., & Si, H. (2016). The effect of the aqueous extract of Bidens pilosa L. on androgen deficiency dry eye in rats. Cellular Physiology and Biochemistry. 39(1). … Continue reading

Notably, these animal models use considerably higher concentrations of finasteride than would be recommended for hair loss – an equivalent dose for the average American man would be around 126 mg per day. In comparison, the standard regimen for AGA is only 1 mg per day. However, they do demonstrate the capacity for finasteride to impact tear production.

Clinical Data

Preclinical data, as well as a deeper understanding of the androgen-associated causes of DED, led to some concern about the potential adverse effects of finasteride.^[13]Traish, A. M. (2020). Health risks associated with long-term finasteride and dutasteride use: it’s time to sound the alarm. The World Journal of Men’s Health. 38(3). 323-337. Available at: … Continue reading 

Recently, clinical researchers have further explored this link. A retrospective case series looked at 116 patients at an eye clinic with a history of DED who were taking finasteride.^[14]Nguyen, B. J., Meer, E., Gupta, A. S., Jinpeng, G., Ying, G. S., Bunya, V. Y., Macchi, I., & Massaro-Giordano, M. (2022). The effect of finasteride on dry eye disease. Investigative Ophthalmology … Continue reading 

They found that a significantly greater proportion of patients had MGD, conjunctival abnormalities, and corneal abnormalities during follow-up examinations compared to their initial assessment, a period of four and a half years on average. 

They also found a trend toward increased disease severity in patients on a higher dose of finasteride, although these findings were not statistically significant. It is hard to draw any conclusions from this research, as it only looked at individuals who both took finasteride and had DED. A retrospective study or clinical trial that included individuals who did not take finasteride would provide significantly greater insights.

Anecdotal reports from an eye clinic in New Zealand have indicated that increasingly, patients presenting with DED are also taking finasteride.^[15]NZ Optics. (2022). Finasteride and dry eye disease. Available at: https://www.nzoptics.co.nz/live-articles/finasteride-and-dry-eye-disease/ (Accessed: October 2025)  Data on the impact of finasteride on DED is, therefore, lacking, and robust clinical studies are required to better understand the potential link.

Some conclusions can also be drawn from clinical studies investigating other antiandrogenic drugs. Such medications are often used against prostate cancer, which depends on androgens such as testosterone and DHT for its growth and survival. A retrospective study compared a group of 1791 patients with prostate cancer who were taking a range of androgen deprivation therapies with those who weren’t.^[16]Chien, H. W., Lin, C. W., Lee, C. Y., Huang, J. Y., Yang, S. F., & Wang, K. (2022). The use of androgen deprivation therapy for prostate cancer and its effect on the subsequent dry eye disease: a … Continue reading They found no significant difference in the development of DED.

A similar study compared a smaller group of prostate cancer patients on antiandrogens (31 in total) to those not on such medications. However, it investigated tear formation in greater depth.^[17]Kurna, S. A., Hacisalihoglu, A. O., Altun, A., Ozel, N. O., Uruc, F., Kanar, H. S., & Arsan, A. K. (2022). Effects of systemic anti-androgen drugs on the ocular surface. Journal Français … Continue reading 

They found a significant increase in markers for tear break-up and complaints of dry eye. Importantly, neither of these studies distinguishes between forms of antiandrogen therapy, nor do they specifically investigate the role of finasteride.

Summary Consensus

Data from animal models provide a clear mechanism by which finasteride could impact tear production and cause MGD and DED. However, the limited availability of clinical data makes it challenging to draw evidence-based conclusions about the potential adverse effects of finasteride. Clinical studies using a wide range of antiandrogen therapies in a different cohort (prostate cancer patients) also provide conflicting information. It’s important to remember that the absence of evidence doesn’t mean definitive proof of absence, and you should still consider the potential effects on your eyes when taking finasteride.

How Might Finasteride Cause Dry Eye?

1. Finasteride reduces DHT: Finasteride blocks 5α-reductase, lowering dihydrotestosterone (DHT) levels in the body.
2. Decreased androgen activity in eyelid glands: Lower DHT means less stimulation of the meibomian glands, which rely on androgens to produce the oils that keep tears in place.
3. Reduced meibum quality and quantity: With reduced androgen influence, these glands produce less oil, thereby decreasing the stability of the tear film.
4. Gland obstruction and dysfunction: Poor-quality meibum can clog gland openings, leading to meibomian gland dysfunction and reduced tear protection.
5. Evaporative tear loss and dry eye symptoms: Tears evaporate more quickly, causing dryness, irritation, and blurred vision.

Secondary effects – Inflammation and surface damage: Ongoing tear film instability can trigger inflammation, discomfort, and damage to the eye’s surface over time.

Who Might Be Most At Risk of DED?

If you’re concerned about the risk of developing DED while taking finasteride, it’s important to consider other risk factors that could have an additive effect.^[18]Britten-Jones, A. C., Wang, M. T., Samuels, I., Jennings, C., Stapleton, F., & Craig, J. P. (2024). Epidemiology and risk factors of dry eye disease: considerations for clinical management. … Continue reading Those at risk include:

Peri-and Post Menopausal Women – The hormonal changes of menopause lead to reduced secretion and quality in both lacrimal and meibomian glands, the core tear-producing tissues

Older People – The risk sharply increases after age 40, with prevalence rising further with each decade due to reduced tear production and gland function.

Contact Lens Wearers – Long-term use is linked to higher DED risk due to tear film disruption.

Screen Users – Reduced blink rate and incomplete blinks from device use elevate risk, especially in professional and urban populations.

Individuals on Certain Medications – Antihistamines, antidepressants, hormone therapies, and diuretics reduce tear secretion or alter tear composition.

People Exposed to Dry, Polluted, or Urban Environments – Low ambient humidity, air conditioning, pollution, and smoke contribute to increased evaporation and instability of the tear film.

How Can I Manage or Prevent Dry Eye While on Finasteride?

Dry eye can often be managed through a combination of lifestyle changes, environmental adjustments, proper eye care, and medical support.^[19]Donthineni, P. R., Shanbhag, S. S., & Basu, S. (2021). An evidence-based strategic approach to prevention and treatment of dry eye disease, a modern global epidemic. Healthcare. 9(1). 89. … Continue reading If you’re taking finasteride and notice eye discomfort or dryness, these steps may help minimize symptoms and protect long-term eye health.

• Avoid smoky environments and consider quitting smoking. Both active and passive smoke can worsen dryness and irritation.
• Take regular eye breaks. Blinking more often and positioning screens slightly below eye level can also help reduce tear evaporation.
• Clean your eyelids daily using a warm compress followed by gentle cleansing with a mild, non-irritating lid cleanser. This can help keep oil glands functioning correctly, especially if you have blepharitis or meibomian gland dysfunction (MGD).
• Apply lubricating eye drops to keep the eyes moist and comfortable.
• Boost your intake of omega-3s through foods such as salmon, mackerel, walnuts, and flaxseed, or consider supplements under your doctor’s guidance. These healthy fats support meibomian gland function and tear quality.
• Protect your eyes from UV rays and dust by wearing sunglasses outdoors. Avoid rubbing your eyes, get sufficient sleep, and maintain a balanced diet rich in vitamins A, C, and E.
• If dryness, irritation, or visual changes continue, see an ophthalmologist or optometrist. They can assess tear quality and meibomian gland health, and may recommend advanced treatments such as prescription eye drops.

What’s Still Unknown

Although preclinical and clinical evidence suggest a possible link between finasteride and DED, many questions remain unanswered. Animal models suggest a causal connection but cannot replicate human physiology, and typically administer much higher doses than those that would be administered in humans. Large, controlled trials investigating the use of finasteride at the 1 mg hair-loss dose are required to draw evidence-based conclusions about the role of finasteride in DED.

Final Thoughts

Finasteride is an effective, well-established, and typically well-tolerated treatment for hair. However, concerns about links to meibomian gland dysfunction and DED are rising. The eye is a hormonally responsive organ, and systemic medications can have subtle but meaningful effects on ocular health. While animal studies and hormonal mechanisms support a potential link to dry eye disease, human data remain limited and inconclusive, especially at the low doses used for androgenic alopecia. For now, users should monitor for symptoms like dryness or irritation and seek ophthalmologic advice if they occur.