Can tirzepatide (glucagon-like peptide-1 (GLP-1) receptor agonist) cause conjunctivitis?

Tirzepatide and Conjunctivitis: Evidence Review

Tirzepatide does not appear to cause conjunctivitis based on current clinical evidence and guidelines. There is no established association between tirzepatide and conjunctival inflammation in the medical literature.

Analysis of Available Evidence

Medication Profile and Known Side Effects

Tirzepatide is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist approved for:

• Treatment of type 2 diabetes 1
• Weight management in obesity 1

The most common documented adverse effects of tirzepatide include:

• Gastrointestinal effects: Nausea (13-18%), diarrhea (13-16%), vomiting (6-10%) 2
• These GI effects are generally mild to moderate in severity but can occasionally be severe 3
• Injection site reactions 1
• Elevated heart rate 1
• Hypoglycemia (0.2-1.7%) 2

Ocular Side Effects in Clinical Evidence

In comprehensive clinical trials and meta-analyses of tirzepatide:

1. The SURPASS clinical trial program (SURPASS 1-5) thoroughly documented adverse events but did not report conjunctivitis as a significant finding 4, 2

2. A systematic review and meta-analysis of 7 trials involving 6,609 participants evaluated the safety profile of tirzepatide and did not identify conjunctivitis as a reported adverse event 5

3. The American College of Physicians' systematic review and network meta-analysis of newer pharmacologic treatments for type 2 diabetes did not list conjunctivitis among tirzepatide's adverse effects 1

4. The American Diabetes Association's 2024 Standards of Care in Diabetes lists potential safety concerns for tirzepatide including:

   • Pancreatitis (though causality not established)
   • Risk of acute kidney injury
   • Gallstone-related complications
   • Gastrointestinal disorders
   • Potential for delayed absorption of oral medications
   • Thyroid C-cell tumors in rodents (black box warning)

   However, conjunctivitis is not mentioned among these concerns 1

Conjunctivitis Etiology and Risk Factors

According to the Conjunctivitis Preferred Practice Pattern from Ophthalmology (2024), common causes of conjunctivitis include:

• Infectious agents (bacterial, viral)
• Allergic reactions
• Topical medications (particularly noted: pilocarpine and timolol) 1
• Systemic conditions like Stevens-Johnson syndrome, vasculitis, and graft-versus-host disease 1

The Allergic Conjunctivitis Guideline notes that medication-induced conjunctivitis is typically associated with:

• Topical glaucoma medications
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Antibiotics
• Antivirals 6

Notably, GLP-1 receptor agonists or dual GIP/GLP-1 receptor agonists like tirzepatide are not listed as known causes of conjunctivitis in these ophthalmology guidelines.

Clinical Implications

1. Monitoring recommendations: While conjunctivitis is not a known side effect of tirzepatide, patients should be advised to report any new eye symptoms for appropriate evaluation.

2. Differential diagnosis: If a patient on tirzepatide develops conjunctivitis, clinicians should consider more common etiologies:

   • Allergic reactions to environmental allergens
   • Viral or bacterial infections
   • Other medications the patient may be taking
   • Underlying systemic conditions

3. Risk-benefit assessment: The absence of conjunctivitis in tirzepatide's side effect profile should not impact prescribing decisions for appropriate patients with type 2 diabetes or obesity.

Conclusion

Based on current clinical evidence and guidelines, tirzepatide has not been associated with conjunctivitis. The medication's known side effect profile primarily includes gastrointestinal effects, with no documented ocular inflammatory conditions in large clinical trials and meta-analyses. If conjunctival inflammation occurs in a patient taking tirzepatide, clinicians should investigate other more likely causes.