The Medical journal of Malaysia · 2025
Isotretinoin-induced severe dry eye disease and meibomian gland alterations in patients with acne vulgaris: A noncontact ocular surface analysis.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Julieana M, Sn-Humaira S M H, Wn-Hasbee W A, Shahidatul-Adha M
Аннотация
INTRODUCTION: Although isotretinoin causes various potentially vision-threatening ocular side effects, it remains widely prescribed for acne vulgaris (AV) globally due to its proven efficacy, particularly in severe or treatment-resistant cases. This study evaluated the effect of isotretinoin on ocular surface parameters to elucidate the underlying mechanisms of isotretinoin-associated dry eye disease (DED).
MATERIALS AND METHODS: A comparative cross-sectional observational study was conducted at two tertiary hospitals between August 2022 and May 2023. A total of 48 patients with AV were recruited and categorised into the isotretinointreated (n=19) and isotretinoin-naive (n=29) groups. A LacryDiag® ocular surface analyser was used to evaluate meibomian gland loss (MGL) and tear film parameters. The Ocular Surface Disease Index (OSDI) questionnaire was administered to evaluate dry eye symptom, severity and functional effects.
RESULTS: At enrollment, the mean duration of AV was 5.26 ± 3.28 and 6.39 ± 5.63 years in the treated and naive groups, respectively. Treated participants had completed at least a minimum of 16 weeks of daily isotretinoin therapy at the time of examination (mean: 16.89 ± 3.2 weeks). The OSDI score was markedly higher in the treated group than that in the naive group (43.20 ± 18.79 vs 18.15 ± 19.24). The isotretinointreated group had a significantly greater MGL percentage than the naive group (p<0.001), significantly lower noninvasive break-up time (NIBUT) (p=0.046) and lipid layer thickness (p<0.001). The mean tear meniscus height was also lower in the treated group, although the difference was not statistically significant (p = 0.462). Pearson's correlation analysis revealed a significantly moderate positive correlation between the MGL percentage and OSDI score (r=0.417, p=0.003) and a significantly moderate negative correlation between MGL percentage and NIBUT (r=-0.348, p=0.015).
CONCLUSION: Isotretinoin therapy in patients with AV is remarkably associated with greater MGL, severe dry eye symptoms, and reduced tear film stability, supporting a lipiddeficient mechanism in isotretinoin-induced DED. Routine ocular surface evaluations are recommended for the early detection and management of ocular complications in patients receiving isotretinoin.
MATERIALS AND METHODS: A comparative cross-sectional observational study was conducted at two tertiary hospitals between August 2022 and May 2023. A total of 48 patients with AV were recruited and categorised into the isotretinointreated (n=19) and isotretinoin-naive (n=29) groups. A LacryDiag® ocular surface analyser was used to evaluate meibomian gland loss (MGL) and tear film parameters. The Ocular Surface Disease Index (OSDI) questionnaire was administered to evaluate dry eye symptom, severity and functional effects.
RESULTS: At enrollment, the mean duration of AV was 5.26 ± 3.28 and 6.39 ± 5.63 years in the treated and naive groups, respectively. Treated participants had completed at least a minimum of 16 weeks of daily isotretinoin therapy at the time of examination (mean: 16.89 ± 3.2 weeks). The OSDI score was markedly higher in the treated group than that in the naive group (43.20 ± 18.79 vs 18.15 ± 19.24). The isotretinointreated group had a significantly greater MGL percentage than the naive group (p<0.001), significantly lower noninvasive break-up time (NIBUT) (p=0.046) and lipid layer thickness (p<0.001). The mean tear meniscus height was also lower in the treated group, although the difference was not statistically significant (p = 0.462). Pearson's correlation analysis revealed a significantly moderate positive correlation between the MGL percentage and OSDI score (r=0.417, p=0.003) and a significantly moderate negative correlation between MGL percentage and NIBUT (r=-0.348, p=0.015).
CONCLUSION: Isotretinoin therapy in patients with AV is remarkably associated with greater MGL, severe dry eye symptoms, and reduced tear film stability, supporting a lipiddeficient mechanism in isotretinoin-induced DED. Routine ocular surface evaluations are recommended for the early detection and management of ocular complications in patients receiving isotretinoin.