Highlighting The Ophthalmic Adverse Effects Associated With Isotretinoin

To review the spectrum of ocular adverse effects associated with systemic isotretinoin, with emphasis on dry eye disease, meibomian gland dysfunction, retinal and neuro-ophthalmic complications, and to highlight practical considerations for co-management between dermatologists, general practitioners, and ophthalmologists.

Narrative review of published clinical and experimental studies examining ocular side effects of systemic isotretinoin in dermatologic practice.

A structured narrative review of peer-reviewed studies was conducted. Evidence regarding dry eye disease, meibomian gland dysfunction, retinal structural and electrophysiological changes, nyctalopia, neuro-ophthalmic manifestations, and corneal alterations was synthesised. Proposed mechanisms, dose-dependence, reversibility, and implications for clinical monitoring were analysed to generate practice-oriented recommendations.

Dry eye disease secondary to meibomian gland dysfunction is the most frequent ocular complication and demonstrates structural and functional gland changes that may partially reverse after drug cessation. Ocular surface instability and symptoms may persist despite gland recovery. Nyctalopia is a dose-dependent and potentially irreversible adverse effect linked to retinal dysfunction. Evidence regarding retinal nerve fiber layer thinning remains inconsistent. Rare but serious complications include idiopathic intracranial hypertension, optic neuritis, and corneal remodelling.

Systemic isotretinoin is associated with predictable ocular surface toxicity and less common but clinically significant retinal and neuro-ophthalmic effects. Early symptom screening, risk stratification (including contact lens use and prior refractive surgery), and timely ophthalmic referral are essential. Collaborative co-management enables continuation of dermatologic therapy while minimizing visual morbidity and addressing vocation-specific risks such as night-vision impairment.