Acid reflux can affect your eyes, though not in the obvious way most people imagine. The connection runs mainly through a condition called laryngopharyngeal reflux (LPR), where stomach contents travel far enough upward to reach the throat and, in some cases, the tear film itself. Researchers have detected pepsin, a stomach enzyme, in the tears of people with reflux, and studies consistently link reflux disorders with dry eye, blocked tear ducts, and ocular surface damage. The relationship is still being mapped out, but the evidence is strong enough that eye doctors, ENTs, and gastroenterologists are increasingly paying attention to it.
How Stomach Contents Can Reach Your Eyes
The route sounds improbable at first. Your tear ducts drain tears from the eye surface down into the nasal cavity through a narrow tube called the nasolacrimal duct. That drainage system is not airtight. CT scans of healthy people have shown air inside the nasolacrimal sac and duct in roughly 29% of cases, suggesting the system can allow material to travel both directions.1PubMed. Gastroesophageal reflux disease and the presence of pepsin in the tears When reflux sends acidic gas and aerosolized stomach contents up into the nasopharynx, some of that material can travel backward through the nasolacrimal duct and reach the eye surface. This retrograde pathway also has a parallel in the ear: the Eustachian tube allows refluxate to reach the middle ear, which is why reflux has long been studied in the context of ear infections and chronic ear problems.
There may also be a more indirect route. Reflux that chronically irritates the nasal mucosa around the lower opening of the nasolacrimal duct can trigger inflammation that swells and eventually scars the duct lining.2PubMed. Does gastroesophageal reflux contribute to development of acquired nasolacrimal duct obstruction? This does not bring stomach contents to the eye directly, but it can block tear drainage and create its own set of eye problems. The point is that anatomically, the throat and the eye surface are not as separated as they seem.
Pepsin in Tears
The most compelling piece of evidence linking reflux to eye damage is the discovery of pepsin in tears. Pepsin is a digestive enzyme that belongs in your stomach and nowhere else. When it shows up in tears, it strongly suggests that gastric material has made it all the way to the ocular surface.
In a study of 50 adults with laryngopharyngeal reflux, about two-thirds had detectable pepsin in their tears, while none of the healthy control subjects did.3PubMed Central. Evidence of Pepsin-Related Ocular Surface Damage and Dry Eye (PROD Syndrome) in Patients with Laryngopharyngeal Reflux The pepsin concentration was not random. It tracked closely with how severe the reflux was and, critically, with how damaged the eye surface appeared. Higher pepsin levels in tears correlated with worse conjunctival redness and more severe corneal staining on clinical examination. The same study found that most LPR patients reported eye symptoms: more than half had redness, about 40% felt a foreign-body sensation, and roughly 38% experienced itching.
A smaller study in children with LPR found pepsin in the tears of 20% of the study group, while all control subjects tested negative.4PubMed. Investigation of pepsin in tears of children with laryngopharyngeal reflux disease The lower percentage in children compared to adults may reflect differences in reflux severity, anatomy, or simply the smaller study size. Either way, the presence of a stomach-specific enzyme in tears is difficult to explain by anything other than reflux reaching the eye.
Researchers have proposed calling this pattern “PROD syndrome,” for pepsin-related ocular surface damage, to give clinicians a framework for recognizing it. One review of the existing evidence found that ocular surface disease scores tend to rise in step with reflux severity scores, with researchers suggesting a specific symptom threshold that could help predict which reflux patients are most likely to have eye involvement.5ScienceDirect / Elsevier (J Voice). Involvement of Laryngopharyngeal Reflux in Ocular Diseases: A State-of-the-Art Review
The Dry Eye Connection
Dry eye disease is probably the most common eye complaint linked to acid reflux. The overlap between the two conditions is striking. In one clinical study, researchers screened 245 patients and found that those with dry eye disease were eight times more likely to have pathologically elevated reflux symptom scores compared to patients without dry eye.6PubMed. Association of Dry Eye with Laryngopharyngeal Reflux in Clinical Practice Even patients who did not meet the formal criteria for dry eye disease still had worse eye symptoms when their reflux scores were high.
Several mechanisms could explain why reflux and dry eye so often appear together. Pepsin reaching the eye surface has direct proteolytic (tissue-digesting) activity that can damage the delicate epithelial cells on the cornea and conjunctiva. Reflux also promotes systemic and local inflammation, and many of the same inflammatory signaling molecules elevated in dry eye tears, including IL-1β, IL-6, and TNF-α, are also triggered by reflux-related tissue damage.7PubMed Central. Dry Eye Disease and Tear Cytokine Levels—A Meta-Analysis Additionally, reflux may disrupt the autonomic nervous system in ways that impair tear production and the stability of the tear film. A 2025 review article summarized the picture: tear film synthesis and stability are often impaired in LPR patients, and the combination of pepsin in tears, shared inflammatory pathways, and autonomic dysfunction makes the link between the two conditions increasingly hard to dismiss.8PubMed Central. Dry Eye Syndrome as a Potential Sequel of Laryngopharyngeal Reflux: Shared Mechanisms and Clinical Implications
If you have persistent dry eyes that do not respond well to artificial tears, and you also deal with throat clearing, hoarseness, a sensation of a lump in your throat, or chronic cough, it is worth considering whether LPR could be contributing to both problems.
Blocked Tear Ducts and GERD
Beyond dry eye, reflux has been linked to a condition called primary acquired nasolacrimal duct obstruction, or PANDO. This is when the tear drainage duct becomes chronically blocked, leading to watery eyes, recurrent eye infections, and sometimes painful swelling near the inner corner of the eye.
A large population-based study that matched over 876,000 GERD patients against controls found that people with GERD had roughly two and a half times the risk of developing a blocked nasolacrimal duct.9Eye. Risk of primary acquired nasolacrimal duct obstruction among gastroesophageal reflux disease patients: a global population-based study The risk was not distributed evenly. Women faced a higher risk than men, and people over 60 had roughly three times the risk of controls in their age group. Having additional conditions like diabetes, high blood pressure, or chronic sinusitis pushed the risk even higher.
The proposed explanation goes back to anatomy. The nasolacrimal duct opens into the nasal cavity, where refluxate can irritate the surrounding mucosa. Over time, repeated chemical irritation may cause the duct lining to swell and eventually scar shut.2PubMed. Does gastroesophageal reflux contribute to development of acquired nasolacrimal duct obstruction? Reflux-driven autonomic nervous system overactivity could also engorge the blood vessels surrounding the duct, compressing it from the outside. This is a less commonly recognized consequence of GERD than heartburn or throat irritation, but for anyone with unexplained chronic tearing or recurrent eye infections, untreated reflux is worth investigating as a contributing factor.
When Reflux Medications Themselves Cause Eye Problems
Here is an irony that catches many people off guard: proton pump inhibitors, the most commonly prescribed medications for acid reflux, are themselves associated with dry eye symptoms. A large population-based study in the Netherlands found a significant link between PPI use and dry eye complaints, even after accounting for the underlying conditions that led people to take the drugs in the first place.10PubMed. Medication use and dry eye symptoms: A large, hypothesis-free, population-based study in the Netherlands
The mechanism is not entirely clear. PPIs suppress stomach acid production, which is their intended purpose, but they also affect other cellular processes throughout the body. Some researchers suspect they may interfere with the function of glands involved in tear production. This creates a difficult situation for reflux patients who develop dry eye: the reflux itself may be damaging the ocular surface, but the medication treating the reflux could also be making their eyes drier. If you are on long-term PPIs and notice worsening dry eye, it is worth raising with your doctor, not to stop the medication unilaterally, but to weigh the balance and possibly add supportive eye care.
The Gut-Skin-Eye Triangle in Rosacea
Rosacea is a chronic skin condition that causes facial redness, visible blood vessels, and sometimes eye involvement known as ocular rosacea. It has long been connected to gastrointestinal problems, particularly Helicobacter pylori infection, which is also a major player in gastritis and peptic ulcers.11PubMed. Ocular rosacea and treatment of symptomatic Helicobacter pylori infection: a case series One case-control study found that rosacea patients were over four times more likely to also have GERD.12PubMed Central. Rosacea, Germs, and Bowels: A Review on Gastrointestinal Comorbidities and Gut–Skin Axis of Rosacea
H. pylori itself has been proposed as a factor in several chronic eye conditions. A systematic review examined whether H. pylori infection could contribute to blepharitis (eyelid inflammation), glaucoma, and a retinal condition called central serous chorioretinopathy. The theory is that the infection triggers oxidative stress and systemic inflammation that can reach the conjunctiva, the trabecular meshwork of the eye (which controls fluid drainage and pressure), and the retina.13PubMed Central. Helicobacter pylori infection and eye diseases: a systematic review The evidence here is still circumstantial, and the review authors noted significant limitations. But the pattern is suggestive: people with gut inflammation, whether from H. pylori, GERD, or both, seem to have higher rates of certain eye problems than would be expected by chance alone.
If you have both rosacea and reflux, and your eyes are red, gritty, or prone to styes, treating the gut component (including testing for H. pylori) may help the eye symptoms more than eye drops alone.
Sjögren’s Syndrome and the Reflux Overlap
Sjögren’s syndrome is an autoimmune condition that attacks moisture-producing glands, causing severe dry eyes and dry mouth. It is worth mentioning here because Sjögren’s patients appear to have a substantially elevated risk of GERD. One nationwide study found the risk was about 2.4 times higher in Sjögren’s patients than in matched controls, with younger patients facing even steeper odds.14PubMed Central / European Journal of Internal Medicine. Increased risk of concurrent gastroesophageal reflux disease among patients with Sjögren’s syndrome: A nationwide population-based study
This matters because if you are being treated for dry eyes and your doctor suspects Sjögren’s, reflux could be compounding the problem through a separate mechanism. Sjögren’s reduces tear production by damaging the lacrimal glands, while reflux damages the eye surface through pepsin exposure and inflammation. Someone with both conditions may find that treating only one side of the equation leaves them with persistent symptoms. The diagnostic challenge is real: chronic dry eye with reflux symptoms could be Sjögren’s with coincidental GERD, reflux-driven dry eye alone, or both processes layered on top of each other. Distinguishing between them usually requires bloodwork for autoimmune markers alongside a thorough reflux workup.
Treating Reflux-Related Eye Symptoms
Standard dry eye treatments, like artificial tears, warm compresses, and lid hygiene, help manage the ocular surface symptoms but do not address the upstream cause when reflux is driving the problem. A few research groups have tested combined approaches that treat both the reflux and the eye simultaneously.
One study evaluated a regimen using specialized eye drops alongside oral supplements containing magnesium alginate, simethicone, and green tea extract in LPR patients with dry eye. Patients who received both the ocular and systemic treatment showed significant improvement not only in their dry eye scores but also in their reflux symptom scores and objective tear film measurements, including Schirmer testing and tear break-up time.15PubMed Central. A new therapeutic approach for the Dry Eye Syndrome in patients with laryngopharyngeal reflux: first data Patients who received eye drops alone showed more modest improvement. A follow-up study with a similar combined approach confirmed these findings, with significant decreases in both reflux and dry eye severity scores after just one month of treatment.16PubMed Central. A combined treatment for patients with dry eye and associated laryngopharyngeal reflux: a real-life approach
These are small, preliminary studies, and the specific formulations tested are not widely available outside of clinical research settings. But the broader lesson is practical: if your dry eye is being driven partly by reflux, getting the reflux under control through dietary changes, sleeping with your head elevated, managing weight, and working with your doctor on appropriate medications is likely to help your eyes more than eye drops can do on their own. Conversely, if you have been treating reflux aggressively but ignoring the eye surface, you may need dedicated ocular treatment to heal damage that has already occurred.
An Important Distinction That Does Not Apply
It is worth noting that not every form of esophageal or gastrointestinal inflammation affects the eyes in the same way. Eosinophilic esophagitis, an allergic inflammatory condition of the esophagus sometimes confused with GERD, has been studied for eye associations, and a multicenter cohort study found no significant link to dry eye syndrome, blepharitis, or meibomian gland dysfunction.17PubMed Central. Eosinophilic esophagitis is associated with increased risk of allergic conjunctivitis: a multicenter cohort study The one eye condition it was linked to was allergic conjunctivitis, which makes sense given its allergic nature. This reinforces that the reflux-eye connection appears to be specific to conditions involving actual gastric contents (acid, pepsin) traveling upward, not just any esophageal inflammation.
Nutrient Absorption and the Cornea
Chronic acid reflux can also affect the eyes through a more roundabout path: nutritional deficiency. Long-term GERD and the medications used to treat it, particularly PPIs, can interfere with the absorption of certain nutrients. Vitamin B12 is one of the better-documented examples. B12 requires stomach acid for proper absorption, and years of acid suppression can gradually deplete levels.
Severe B12 deficiency can cause a condition called neurotrophic keratopathy, where the corneal nerves lose function and the cornea becomes unable to properly sense irritation or heal itself. A case report described a 34-year-old man with progressive vision loss and corneal damage traced to B12 deficiency, whose condition dramatically improved within three weeks of B12 supplementation, with corneal sensation returning and visual acuity increasing.18PubMed Central. Vitamin B12 Deficiency as a Cause of Neurotrophic Keratopathy This is an uncommon scenario, but it illustrates that the eyes can be a downstream casualty of chronic digestive problems even when no refluxate directly contacts them. If you have been on PPIs for years and develop unexplained corneal problems or changes in vision, checking your B12 level is a simple and worthwhile step.