Isotretinoin and the eye: A review for the dermatologist

Abstract

Due to the prevalence of acne vulgaris, isotretinoin is one of the most prescribed drugs among physicians and dermatologists. Although exhibiting an adequate safety profile, adverse events secondary to isotretinoin use are common. Before prescribing isotretinoin, physicians usually inquire about pregnancy and perform serologic tests including cholesterol, triglycerides, and liver enzymes. Ocular manifestations are commonly neglected. Despite being generally mild, ocular manifestations related to either topical or systemic isotretinoin may cause important ocular morbidity. The ocular surface is the most affected site within the eye; however, retinal and optic nerve disease also have been documented. Evaporative dry eye disease, which may range from mild to severe, is the most common adverse ocular effect associated with isotretinoin use. The aim of this review is to present an up-to-date overview for the dermatologist about the prevention, diagnosis, and treatment of the ocular side effects of isotretinoin, and when to refer to the eye specialist.

Dermatologists’ Knowledge and Attitudes Toward Dry Eye Disease, Refractive Surgery, and Contact Lenses When Prescribing Isotretinoin in Saudi Arabia

“…1 Previous studies reported several ocular side effects in the use of isotretinoin. 1,2,6 Almost all dermatologists who completed the survey were aware that dry eye disease is a common ocular adverse effect of isotretinoin and prescribed lubricant eye drops.…”

“…However, it is essential to refer the patient to an ophthalmologist before starting isotretinoin if the patient is known to have severe dry eye disease and during the isotretinoin course if the patient develops symptoms, such as unresponsive dry eye, ocular pain, decreased vision, reduced night vision, visual field alterations, color perception alterations, chalazion, and hordeolum. 6 Laser refractive surgery is a very common procedure in persons between 18 and 30 years of age. This overlaps with the population of patients with acne, whose average age is 24 years.…”

Dermatologists’ Knowledge and Attitude Toward Isotretinoin Ocular Side Effects in Egypt

“…Ruiz-Lozano et al 2020 reported photophobia, corneal opacities, keratitis, refractive visual disturbances (day/night vision disturbances), color vision impairment, and papilledema as rare adverse reactions. 4 …”

“…3 The eyes are one of these systems, where isotretinoin causes reversible atrophy of the meibomian gland. 4 Fraunfelder et al 2001 classified dry eye disorders as a "certain" side effect for isotretinoin. 5 They reported 38 cases with decreased tolerance to contact lens.…”

“…6 Ruiz-Lozano et al 2020 reported photophobia, corneal opacities, keratitis, refractive visual disturbances (day/ night vision disturbances), color vision impairment, and papilledema as rare adverse reactions. 4 There is a difference between the dermatological and the ophthalmological perceptions of isotretinoin. For dermatologists, it is one of the most effective and available acne treatments.…”