Isotretinoin and Dry Eye Disease: A Systematic Review

PURPOSE: Isotretinoin reduces the production and spread of sebaceous glands in the skin but can also affect the sebaceous glands of the eyelids, the meibomian glands, leading to dry eye disease (DED). The purpose of this study is to systematically review the evidence regarding the effects of isotretinoin on ocular surface parameters and its association to DED. METHODS: Ovid), Embase, Scopus, and the Cochrane Central Register of Controlled Trials databases. Independent screening of titles, abstracts and full-text articles was performed by two authors. RESULTS: A total of 43 articles were included in this review. Across prospective studies evaluating ocular surface parameters, worsening of dry eye symptoms and objective signs of ocular surface disease was frequently reported, particularly for measures of meibomian gland structure and function. Six studies evaluated interventions intended to reduce isotretinoin-associated adverse effects, of which four reported improvements in symptoms or ocular surface parameters. CONCLUSION: Dry eye disease appears to be a common and potentially serious side effect of isotretinoin. The drug may cause persistent alterations to the sebaceous glands in some patients, although the long-term extent and clinical significance remain uncertain. Patients should be informed about potential ocular complications and screened for symptoms of DED before and during isotretinoin treatment.