Can Eye Drops Raise Blood Pressure? A Guide to Systemic Side Effects

October 11, 2025 •

4 min read

According to the National Institutes of Health, a significant portion of a drug administered via eye drops may enter the systemic circulation, leading to unintended side effects. Certain ophthalmic medications, such as vasoconstrictors and specific glaucoma treatments, contain active ingredients that can indeed raise blood pressure, especially in sensitive individuals.

Quick Summary

Eye drop medications can be absorbed into the bloodstream through the nasal mucosa, potentially affecting blood pressure. Vasoconstrictors, corticosteroids, and certain glaucoma medications are most likely to cause systemic side effects, particularly in at-risk patients.

Key Points

Systemic Absorption is Key: Eye drops can be absorbed into the bloodstream through the nasal passages, bypassing the liver's metabolism, and causing effects throughout the body.
Vasoconstrictors Are High-Risk: Over-the-counter eye drops containing vasoconstrictors like phenylephrine can cause a rise in blood pressure, especially with frequent use.
Certain Glaucoma Drops Cause Increases: Alpha-adrenergic agonists used for glaucoma, such as brimonidine, are known to potentially increase blood pressure and heart rate.
At-Risk Groups Need Caution: Elderly patients, children, and individuals with pre-existing conditions like hypertension or heart disease are more susceptible to systemic side effects.
Proper Technique Minimizes Risk: Using nasolacrimal occlusion—pressing on the inner corner of the eye after application—can prevent drainage and significantly reduce systemic absorption.
Side Effects Are Dose-Dependent: The risk of cardiovascular side effects from eye drops increases with higher drug concentrations.

How Eye Drops Affect the Entire Body

While eye drops are designed for localized treatment, they are not always confined to the eye itself. After instillation, the medication can drain through the nasolacrimal duct into the nasal cavity, which is rich with blood vessels. From there, the drug can be absorbed directly into the systemic circulation, bypassing the initial metabolic processes in the liver that would normally break down the compound. This process, known as systemic absorption, is the primary reason some eye drops can influence blood pressure and other body functions.

Several factors can increase the risk of systemic absorption:

Higher concentration: A more concentrated dose of a drug leads to greater systemic exposure.
Damaged corneal epithelium: A damaged cornea, due to injury or disease, can increase drug penetration.
Conjunctival hyperemia: Increased blood flow to the conjunctiva can facilitate absorption.
Improper technique: Failing to use proper eye drop administration techniques, such as punctal occlusion, can lead to more medication draining into the nasal cavity.

Eye Drops That Can Raise Blood Pressure

Over-the-Counter (OTC) Vasoconstrictors

Many OTC eye drops designed to relieve eye redness contain vasoconstrictors, which constrict the small blood vessels in the conjunctiva to make the eyes appear whiter. These active ingredients work systemically if absorbed and can have cardiovascular effects.

Common Ingredients: Phenylephrine and tetrahydrozoline are common vasoconstrictors found in brands like Visine.

Mechanism of Action: These ingredients mimic the effects of adrenaline by acting on adrenergic receptors throughout the body, including those in the cardiovascular system. This can lead to an increase in blood pressure and heart rate.

Risks: While a single dose is unlikely to cause a significant issue for most healthy people, repeated use or higher concentrations can be problematic. The risk is elevated for individuals with pre-existing heart conditions, hypertension, thyroid problems, or those using certain medications like MAO inhibitors.

Prescription Glaucoma Medications

Some medications used to treat glaucoma or ocular hypertension also have the potential to affect blood pressure and heart function.

Alpha-Adrenergic Agonists (e.g., Brimonidine): These drugs reduce the production of fluid in the eye and increase outflow. Side effects can include fatigue, dizziness, and a mild increase in blood pressure. It is important to note that other alpha agonists like apraclonidine can also cause hypertension.
Beta-Blockers (e.g., Timolol): This is a key point of confusion for many. While some glaucoma drops (like beta-blockers) can cause side effects like low blood pressure and a slow heart rate, it is the alpha-adrenergic agonists that can cause an increase in blood pressure. This distinction is critical for patient management. Systemic absorption of beta-blocker eye drops is also possible, especially when combined with oral beta-blockers.

Corticosteroid Eye Drops

Topical steroid drops, such as prednisolone, are used to treat inflammation in the eye. While systemic absorption is generally minimal, prolonged use, especially in higher concentrations, can lead to systemic side effects. These can include an increase in blood pressure and blood sugar, particularly in individuals with predisposing risks.

At-Risk Patient Populations

Certain groups are more vulnerable to the systemic effects of eye drops and should exercise extra caution:

Elderly individuals: Age-related changes and polypharmacy (the use of multiple medications) increase the risk of adverse drug interactions and side effects.
Individuals with pre-existing conditions: People with a history of heart problems, high blood pressure, thyroid disease, or diabetes are at higher risk.
Children: Infants and young children have thinner mucous membranes and smaller body mass, making them more susceptible to systemic absorption. High concentrations of certain mydriatic drops (like phenylephrine) have been shown to have cardiovascular effects in pediatric patients.

How to Minimize Systemic Absorption

To prevent eye drops from reaching the bloodstream and causing systemic side effects, patients can use a technique called nasolacrimal occlusion.

Steps for Proper Instillation and Occlusion:

Wash hands thoroughly before beginning.
Tilt head back and create a small pocket by pulling down the lower eyelid.
Instill one drop into the pocket, avoiding contact between the dropper and the eye.
Close the eye gently and immediately press a finger on the inner corner of the eyelid, near the nose.
Hold this pressure for 1 to 3 minutes to block the tear duct and prevent drainage.
Wipe away any excess medication from the cheek.

Comparison of Eye Drop Categories and Blood Pressure Effects


Eye Drop Category	Example Ingredients	Effect on Blood Pressure	Risk Factors	Recommendations
Vasoconstrictors	Phenylephrine, Tetrahydrozoline	Increase	High blood pressure, heart disease, thyroid issues	Use cautiously; avoid prolonged use
Alpha Agonists	Brimonidine, Apraclonidine	Increase	Pre-existing hypertension, cardiac issues	Monitor blood pressure; use with caution
Beta-Blockers	Timolol, Betaxolol	Decrease	Existing hypotension, bradycardia, asthma	Monitor heart rate and blood pressure
Corticosteroids	Prednisolone	Increase (mild)	Pre-existing hypertension, diabetes	Long-term use should be monitored
Prostaglandins	Latanoprost, Bimatoprost	Less likely (minor)	Generally low systemic risk for BP changes	Consider as first-line for glaucoma with fewer systemic side effects
Carbonic Anhydrase Inhibitors	Dorzolamide, Brinzolamide	Less likely (mild taste disturbances, minor effects)	History of sulfa allergy	Lower systemic absorption than oral versions

Conclusion

While most eye drops do not cause a significant change in blood pressure, the potential for systemic side effects is real, especially for certain classes of medication and in at-risk individuals. Patients using over-the-counter vasoconstrictors, corticosteroids, or alpha-adrenergic glaucoma treatments should be aware of the potential for blood pressure elevation. By understanding the mechanism of systemic absorption and practicing proper application techniques like nasolacrimal occlusion, patients can significantly reduce their risk. Always discuss concerns about eye drops and their potential side effects with a healthcare provider, particularly if you have pre-existing cardiovascular conditions.
For more information on proper eye drop administration, visit the Glaucoma Research Foundation website: Putting in Eye Drops.

Disclaimer: This information is for educational purposes and is not a substitute for professional medical advice. Always consult with a healthcare provider for any health concerns or before making decisions about your treatment.

Frequently Asked Questions

Eye drops containing vasoconstrictors (like phenylephrine and tetrahydrozoline) and alpha-adrenergic agonists (like brimonidine) are most likely to increase blood pressure due to their systemic effects.

Yes, over-the-counter eye drops like Visine, which contain the vasoconstrictor tetrahydrozoline, can cause high blood pressure if enough of the active ingredient is absorbed into the bloodstream.

To prevent systemic absorption, perform nasolacrimal occlusion by pressing on the inner corner of your eye for 1-3 minutes after applying the drops. This blocks the tear duct, stopping the medication from draining into your nose.

Many glaucoma drops are safe, but some, like alpha-adrenergic agonists, can increase blood pressure. Beta-blocker drops actually lower blood pressure. It is crucial to discuss your full medical history with your doctor to select the appropriate medication.

Systemic absorption can cause symptoms such as headache, palpitations, rapid heart rate, or dizziness. If you experience these after using eye drops, contact your healthcare provider.

Topical steroid eye drops like prednisolone can cause a mild, temporary increase in blood pressure, especially with long-term use. The risk is higher in individuals with pre-existing risks. It is important to monitor your blood pressure closely.

Alpha-adrenergic agonist drops can increase blood pressure, while beta-blocker drops can lower blood pressure and heart rate. Your doctor will consider these effects when prescribing glaucoma medication.