isotretinoin and Eyelid-Diseases

The authors have reviewed the potential etiology and long-standing consequences of isotretinoin use in the development of dry eye symptoms in the absence of significant clinical findings. Despite the normal appearance of meibomian gland structure on meibography and minimal signs of eyelid margin inflammation, the secretory function of these glands is reduced and symptoms of dryness can greatly impact a patient's quality of life. The available literature indicates that isotretinoin's effect on the meibomian glands likely mimics its effects on the sebaceous glands of the skin in the treatment of acne. Several representative cases seen at the University of California Berkeley School of Optometry Dry Eye Clinic provide a clinical paradigm with the goal of raising awareness of the potential prevalence of this disease in patients who experience symptoms of dry eye. These cases highlight the importance of meibomian gland expression in determining whether there is poor quality and/or quantity of meibum secondary to reduced gland function. Currently, there is no definitive method to restore the structure and function of damaged meibomian glands; thus, treatment options for isotretinoin-associated meibomian gland dysfunction are primarily palliative to manage patient symptoms.

Topics: Animals; Dermatologic Agents; Dry Eye Syndromes; Eyelid Diseases; Humans; Isotretinoin; Meibomian Glands; Tears

The aim of study was to evaluate the effects of oral isotretinoin on meibomian gland (MG) morphology detected with non-contact meibography and to investigate its relation with clinical dry eye tests.. Forty-five acne patients treated with isotretinoin underwent a full ophthalmological examination at baseline and in the fourth month as follows: ocular surface disease index (OSDI) questionnaire, assessments of tear film break-up time (TFBUT), corneal fluorescein staining, Schirmer test, meibum expression, and lid margin abnormalities. Non-contact meibography imaging and noninvasive tear break up time (NI-BUT) assessments were also performed. The changes in MGs were scored (meibography score) as grade 0, no change; grade 1, mild; grade 2, moderate; and grade 3, marked.. There was a statistically significant change in OSDI, corneal fluorescein staining, lid margin abnormality, and meibum expression score during the treatment compared to baseline values (. The morphologic analysis using non-contact meibography is a useful method for assessing isotretinoin-related changes in MGs.

Topics: Dry Eye Syndromes; Eyelid Diseases; Humans; Isotretinoin; Meibomian Glands; Tears

To evaluate the changes in ocular surface and functions of tear-film in patients treated with systemic isotretinoin, to assess diagnostic performance of ocular surface disease index (OSDI) test in the dry eye conditions in association with the use of isotretinoin, and to determine the correlation between all tear-film function tests, OSDI and the dose and duration of isotretinoin administration. One hundred and twenty eyes of 60 subjects treated with oral isotretinoin were enrolled. All patients underwent ophthalmic examination at the baseline and another examination during the course of treatment. Biomicroscopic ophthalmic examination of the meibomian glands, non-anesthetized Schirmer test, and tear film break-up time (BUT) were performed. Subjective ocular complaints were scored with an OSDI questionnaire. Average Schirmer scores were not significantly changed by isotretinoin treatment. There were significant differences in the average OSDI score, the average meibomian gland disease (MGD) grade and average BUT value of both eyes during the treatment compared with baseline values (p < 0.01). There was a statistically significant inverse correlation between MGD grade and BUT value. There was no significant correlation between BUT value, OSDI score, Schirmer score, MGD grade, the total and divided dose of isotretinoin and the duration of treatment. The follow-up time was 4.01 ± 1.3 months (range 1.5-6 months). Systemic isotretinoin treatment can cause alterations in the tear film and dry eye symptoms. The OSDI test can be used as a diagnostic test for patients receiving systemic isotretinoin treatment.

Topics: Acne Vulgaris; Adolescent; Adult; Cornea; Dermatologic Agents; Dry Eye Syndromes; Eyelid Diseases; Female; Humans; Isotretinoin; Male; Meibomian Glands; Severity of Illness Index; Surveys and Questionnaires; Tears; Young Adult

Isotretinoin broad effectiveness is limited by its detrimental effect on the Meibomian glands. Androgens have been reported to regulate the Meibomian gland function. Dehydroepiandrosterone (DHEA) is an androgen precursor considered as an efficient and physiological anti-ageing skin agent. This study aimed to investigate the role of the topical DHEA in ameliorating Meibomian gland dysfunction caused by isotretinoin employing different histological and immunohistochemical techniques. Twenty-four adult male albino rats were divided into four equal groups; control group, DHEA-treated group (1% twice daily for 3 months), isotretinoin-treated group (0.5mg/kg/day for 3 months), and both isotretinoin and DHEA-treated group. Meibomian gland specimens were processed for light microscopy. Immunohistochemical study was carried out using antibodies for proliferating cell nuclear antigen (PCNA), androgen receptor (AR) and estrogen receptor-alpha (ER-α). Sections from the isotretinoin-treated group revealed a reduction in the number and size of acini. Thickening and keratinization of the epithelial lining of the ducts were observed. Multiple degenerated acini and casts of acinar cells in the ducts of Meibomian glands were detected. Some dilated congested blood vessels and mononuclear cells were occasionally seen. A significant decrease in PAS reaction and a significant increase in collagen fiber content were detected. Immunohistochemical study revealed a significant increase in immunoexpression of PCNA in basal ductal cells coupled with decreased expression in basal acinar cells. Both AR and ER-α immunoexpression was significantly decreased. Minimal alterations were observed upon concomitant treatment with isotretinoin and DHEA as compared to the control group. Topical DHEA could prove to be beneficial in ameliorating isotretinoin-induced Meibomian gland dysfunction most probably through its androgenic effect.

Topics: Administration, Topical; Albinism; Animals; Dehydroepiandrosterone; Dermatologic Agents; Dose-Response Relationship, Drug; Drug Interactions; Estrogen Receptor alpha; Eyelid Diseases; Isotretinoin; Male; Meibomian Glands; Mice; Proliferating Cell Nuclear Antigen; Receptors, Androgen; Treatment Outcome

It is well known that oral isotretinoin treatment causes numerous ocular side-effects.. To investigate the effect of systemic isotretinoin treatment on central corneal thickness (CCT) values due to meibomian gland disease (MGD).. In this prospective study, 47 patients (27 men, 20 women) with nodulocystic acne vulgaris treated with oral isotretinoin (0.8 mg/kg daily) were included.. All patients were analyzed with the Pentacam Scheimpflug topography at baseline, on the 3rd and 6th month of treatment. Main outcome measures were MGD scores and CCT.. The mean age of patients was 25.1 ± 4.4 years. The mean MGD scores were significantly higher at 3rd month (1.3 ± 0.9) and 6th month (1.5 ± 1.0) of treatment compared with baseline (1.1 ± 0.9) (p < 0.001). The mean CCT value at baseline was 540.5 ± 22.1 µm; 536.9 ± 20.5 µm at 3rd month and 531.4 ± 22.2 µm at 6th month. The differences between baseline and 6th month CCT measurements were statistically significant (p < 0.001). There was negative correlation between mean MGD scores and CCT values at the 6th month of treatment which was statistically significant (p = 0.038, r = -0.221).. Isotretinoin treatment causes higher MGD scores. A statistically significant decrease in CCT due to MGD was detected at 6th month of treatment.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Cornea; Dermatologic Agents; Eyelid Diseases; Female; Humans; Isotretinoin; Male; Meibomian Glands; Prospective Studies; Young Adult

Topics: Acyclovir; Adult; Edema; Eyelid Diseases; Facial Dermatoses; Herpes Simplex; Humans; Hypersensitivity, Immediate; Isotretinoin; Male

Systemic treatment of adult male New Zealand albino rabbits with 13-cis-retinoic acid (isotretinoin) resulted in a reduction in the size of the meibomian gland. Clinical signs of toxicity included weight loss, alopecia, dry skin and mild conjunctival erythema with crusting on the eyelid margin. Histopathologic findings included thickening of duct and ductule epithelium, decrease in acinar tissue, accentuation of basaloid cells and evidence of periacinar fibrosis. The model presents the first experimental data to indicate that systemic 13-cis-retinoic acid effects meibomian gland structure in a laboratory model. Future functional studies of this model may yield important insights into the relationships between meibomian gland morphology, function, the ocular surface and the pathogenesis of blepharo-conjunctivitis.

Topics: Alopecia; Animals; Blepharitis; Body Weight; Conjunctivitis; Eyelid Diseases; Isotretinoin; Male; Meibomian Glands; Rabbits

A total of 261 adverse ocular reactions occurred in 237 patients who received isotretinoin, a commonly used drug in the treatment of severe cystic acne. Blepharoconjunctivitis, subjective complaints of dry eyes, blurred vision, contact lens intolerance, and photodermatitis are reversible side effects. More serious ocular adverse reactions include papilledema, pseudotumor cerebri, and white or gray subepithelial corneal opacities; all of these are reversible if the drug is discontinued. Reported cases of decreased dark adaptation are under investigation. Isotretinoin is contraindicated in pregnancy because of the many reported congenital abnormalities after maternal use (including microphthalmos, orbital hypertelorism, and optic nerve hypoplasia).

Topics: Acne Vulgaris; Cataract; Conjunctivitis; Cysts; Eye; Eye Diseases; Eyelid Diseases; Humans; Inflammation; Isotretinoin; Photosensitivity Disorders; Skin Diseases; Tretinoin; Vision Disorders

Topics: Acne Vulgaris; Blepharitis; Conjunctivitis; Eyelid Diseases; Humans; Isotretinoin; Tretinoin