The impact of systemic isotretinoin treatment on the tear film, meibomian glands, and corneal endothelium

Abstract

Purpose

The study aims to investigate changes in tear function, meibomian glands and corneal endothelium in patients receiving systemic isotretinoin therapy.

Materials and methods

This prospective study included 38 eyes from 38 patients (23 females and 15 males) treated with systemic isotretinoin (0.5–1 mg/kg/day) following the diagnosis of acne vulgaris. All patients underwent a comprehensive ophthalmologic examination at baseline, 1st month, and third month of treatment. Subjective complaints were assessed using the Ocular Surface Disease Index (OSDI). Tear functions were evaluated through non-invasive tear break up time (NIBUT) and Schirmer I test. Meibomian gland (MG) changes were examined using meibography. Corneal parameters, including endothelial cell density (ECD), coefficient of variation (CV), the number of cells with a hexagonal shape (6A), average cell area (AVG), and central corneal thickness (CCT) were assessed using non-contact specular microscopy.

Results

The mean age of the patients was 19.29 ± 2.83 years. Ocular surface-related discomfort, measured with OSDI scores, significantly worsened at the third month measurements compared to the pre-treatment values (p < 0.001). In the 1st month of treatment, there was a significant decrease in NIBUT (p < 0.05). No statistically significant difference was found in the Schirmer test results at each visit. According to the 1st and third-month analysis, there was a significant increase in MG loss compared to the pre-treatment period (p < 0.001). ECD, CV, 6 A, AVG measurements at the first and third months showed a significant change compared to the pre-treatment values (p < 0.001). No significant difference was observed in the CCT measurements during the treatment.

Conclusion

Systemic isotretinoin disrupted tear stability, caused MG loss, deterioration in corneal endothelium, and led to symptomatic complaints in patients.

Keywords:

• Cornea
• endothelium
• isotretinoin
• meibomian gland
• tear

Acknowledgements

We would like to thank Dr. Mahmure Şehirli Kara, Dr. Büşra Acar Mantar and Dr. Hakkı Uzun for their support to our study. This work was presented in part at the 52nd Turkish Ophthalmology Society National Congress (November,13–18 2018, Antalya, Turkey) and the Blacksea 5th Symposia on Dermatological Innovations (June 23–25 2023, Ordu, Turkey).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions statement

Both KD and FU were involved in the conception and design, analysis and interpretation of the data; the drafting of the paper, revising it critically for intellectual content; and the final approval of the version to be published; and all authors agree to be accountable for all aspects of the work.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.