isotretinoin and Night-Blindness

Isotretinoin is an effective and increasingly popular treatment for acne vulgaris. There have been reports of night blindness as a side-effect of treatment although the evidence does not demonstrate a clear causal relationship between isotretinoin therapy and the risk of night blindness. Nevertheless, considering the lack of evidence in this area, it is important to educate patients about this potential consequence, which may become longstanding and even irreversible, and encourage them to promptly report changes in their night vision.

Topics: Acne Vulgaris; Animals; Dermatologic Agents; Humans; Isotretinoin; Night Blindness

To analyze whether an abnormal retinal function in patients with a cutaneous malignant melanoma was due to paraneoplastic retinopathy or due to isotretinoin or interferon-alpha.. We studied 15 patients with malignant melanoma in stage IIa and IIb who are all participants in a randomized, multicentered, double-blind placebo-controlled clinical trial comparing interferon-alpha/isotretinoin versus interferon-alpha/placebo performed by the Department of Dermatology, University of Graz. Our assessment included a full ophthalmic history and examination, electrophysiological testing (ERG, EOG), dark adaption, color vision and visual field testing.. The most prevalent ocular symptom patients complained about was ocular dryness (8 patients). Electrophysiological as well as psychophysical testings showed no abnormalities in 12 patients. In 1 patient the therapy was stopped because of electrophysiological and psychophysiological pathology. This patient suffered from severe reduction of night vision and visual disturbances. Another patient had had night blindness since childhood which remained stable.. We postulate that in 1 of 15 patients, visual complaints are caused with a high probability by melanoma-associated retinopathy although, in the literature, isotretinoin is described to show similar effects on retinal function.

Topics: Aged; Antineoplastic Agents; Color Perception; Double-Blind Method; Drug Therapy, Combination; Electroretinography; Female; Humans; Interferon-alpha; Isotretinoin; Male; Melanoma; Night Blindness; Paraneoplastic Syndromes; Prognosis; Retinal Diseases; Skin Neoplasms; Visual Acuity; Visual Fields

The purpose of our study is to find out in which weeks and in which cumulative doses the side effects emerge and to study whether or not there is a significant variance between the observed period and doses of the emergent side effects of the patients taking the daily doses of below and above 0.5 mg/kg.. Patients were started treatment with doses of 0.25-1 mg/kg isotretinoin, and a form was given to the patients to mark which probable side effects occurred in which weeks and called for weekly follow-up for the first 2 months.. The median of the complaints of emerged side effects such as chellitis, dry face and facial erythema, photobia and nyctalopia was in less than 4 weeks. When the doses taken below and above 0.5 mg/kg are compared, the side effects observed to have differences between both the week they occurred and the cumulative doses are xerosis, dry face, exacerbation of acnes, nervousness, and somnolence.. We believe that knowing which weeks the side effects are observed first, warning about the side effects that may especially occur in the first 4 weeks, and ensuring some measures are taken before the side effects are observed will increase the success of patient compatibility and management of side effects.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Erythema; Face; Female; Humans; Isotretinoin; Male; Night Blindness; Young Adult

Topics: Acne Vulgaris; Administration, Oral; Adult; Dermatologic Agents; Female; Humans; Isotretinoin; Night Blindness

Topics: Dark Adaptation; Dose-Response Relationship, Drug; Humans; Isotretinoin; Keratolytic Agents; Night Blindness; Vision Disorders

To evaluate whether previous isotretinoin use induces permanent, measurable, and clinically significant abnormalities in night vision such that flying is precluded, and whether potential military and civilian commercial aviators should be screened routinely.. A retrospective, non-interventional, consecutive case series of 47 individuals with a confirmed history of oral isotretinoin use were compared to 20 age and sex matched controls.. 47 individuals (44 males and three females), age range 17-33, underwent Goldmann-Weekers dark adaptation (DA) and standard electroretinogram (ERG) according to ISCEV protocols. 34 patients showed no abnormality in any parameters. Two patients had abnormal DA and ERGs. The mean scotopic ERG b wave amplitude of the isotretinoin group was 496.5 microV (SD 51.3 microV) compared with 501.7 microV (62.3.1 microV) among the controls. The group mean a:b ratio was 0.55 (0.04) compared to 0.69 (0.08) in the controls.. Previous use of isotretinoin may have caused retinal toxicity in two subjects and laboratory evidence of night blindness in 11 further subjects. One subject had subclinical changes remaining in the ERG 96 months after cessation of isotretinoin. This may justify the directed use of electrophysiological screening in professions that are night vision critical.

Topics: Adolescent; Adult; Aerospace Medicine; Career Choice; Dark Adaptation; Electroretinography; Female; Humans; Isotretinoin; Keratolytic Agents; Male; Night Blindness; Occupational Health; Personnel Selection; Retinal Diseases; Retrospective Studies; Vision Disorders

Topics: Adolescent; Animals; Child; Dietary Supplements; Drug Labeling; Humans; Isotretinoin; Meat; Mental Disorders; Mice; Night Blindness; Rats; Retinal Rod Photoreceptor Cells; Vegetables; Vitamin A; Vitamin A Deficiency

Isotretinoin (13-cis retinoic acid) is frequently prescribed for severe acne [Peck, G. L., Olsen, T. G., Yoder, F. W., Strauss, J. S., Downing, D. T., Pandya, M., Butkus, D. & Arnaud-Battandier, J. (1979) N. Engl. J. Med. 300, 329-333] but can impair night vision [Fraunfelder, F. T., LaBraico, J. M. & Meyer, S. M. (1985) Am. J. Ophthalmol. 100, 534-537] shortly after the beginning of therapy [Shulman, S. R. (1989) Am. J. Public Health 79, 1565-1568]. As rod photoreceptors are responsible for night vision, we administered isotretinoin to rats to learn whether night blindness resulted from rod cell death or from rod functional impairment. High-dose isotretinoin was given daily for 2 months and produced systemic toxicity, but this caused no histological loss of rod photoreceptors, and rod-driven electroretinogram amplitudes were normal after prolonged dark adaptation. Additional studies showed, however, that even a single dose of isotretinoin slowed the recovery of rod signaling after exposure to an intense bleaching light, and that rhodopsin regeneration was markedly slowed. When only a single dose was given, rod function recovered to normal within several days. Rods and cones both showed slow recovery from bleach after isotretinoin in rats and in mice. HPLC analysis of ocular retinoids after isotretinoin and an intense bleach showed decreased levels of rhodopsin chromophore, 11-cis retinal, and the accumulation of the biosynthetic intermediates, 11-cis and all-trans retinyl esters. Isotretinoin was also found to protect rat photoreceptors from light-induced damage, suggesting that strategies of altering retinoid cycling may have therapeutic implications for some forms of retinal and macular degeneration.

Topics: Animals; Isotretinoin; Light; Male; Mice; Mice, Inbred C57BL; Night Blindness; Rats; Rats, Sprague-Dawley; Retinal Cone Photoreceptor Cells; Retinal Rod Photoreceptor Cells; Rhodopsin; Vision, Ocular

A 16-year-old male developed night blindness 2 weeks after starting isotretinoin at a dose of 20 mg per day for cystic acne. He also had cystic fibrosis, complicated by hepatic cirrhosis. Despite long-term oral vitamin A supplementation, serum vitamin A levels were found to be 0.3 mumol/L (normal range 0.9-2.5 mumol/L). Oral vitamin A replacement was instituted with resolution of his visual symptoms in 6 months. Isotretinoin therapy was successfully continued with no deterioration in liver function. Isotretinoin has been reported to cause deterioration in night vision. In vitro evidence suggests isotretinoin may interfere with the processing of endogenous vitamin A in the retina. This case highlights the need for careful monitoring of serum vitamin A status in patients with malabsorptive states on isotretinoin therapy.

Topics: Acne Vulgaris; Adolescent; Cystic Fibrosis; Dermatologic Agents; Humans; Isotretinoin; Liver Cirrhosis; Male; Night Blindness; Risk Factors; Vitamin A Deficiency

Topics: Acne Vulgaris; Adult; Humans; Isotretinoin; Male; Night Blindness

A 16-year-old girl treated with isotretinoin at a dosage of 0.7 mg per kg each day experienced severe headaches and impaired night vision two months after the start of therapy. Bilateral papilledema and narrowing of the lateral ventricles of the brain were found. Pseudotumor cerebri and impaired night vision abated when isotretinoin was discontinued and systemic corticosteroids (dexamethasone) were administered.

Topics: Acne Vulgaris; Adolescent; Female; Humans; Isotretinoin; Night Blindness; Pseudotumor Cerebri

Isotretinoin (Accutane Capsules) is a synthetic vitamin A compound used for treatment of recalcitrant cystic acne. It has numerous ocular toxic side effects which include anterior segment inflammation, dry eye syndrome, contact lens intolerance, altered refraction, photosensitivity, and reduced night vision. Eye care practitioners should be aware of these potential side effects and be prepared to communicate with the prescribing physician if side effects present.

Topics: Anterior Eye Segment; Epithelium; Eye Diseases; Humans; Isotretinoin; Night Blindness; Papilledema; Photosensitivity Disorders; Refraction, Ocular; Reproduction; Retina; Tretinoin; Vitamin A