Dermatologist have Knowledge Gaps Regarding Isotretinoin Eye Side Effects

Counselling Regarding Isotretinoin Eye Side Effects Often Comes Up Short.

Isotretinoin is a medication that is commonly used for advanced cases of nodulocystic acne. The drug was formerly marketed under then name Accutane but is now marketed under many different names in different countries including Absorica, Absorica LD, Claravis, Amnesteem, Myorisan, Epuris, Clarus, and Zenatane).

For dermatologists who treat hair loss, isotretinoin is used ‘off label’ for many treating many hair loss conditions including lichen planopilaris, frontal fibrosing alopecia, folliculitis decalvans, dissecting cellulitis. Knowledge about the risks of isotretinoin is important for all prescribers.

It is well known that isotretinoin can affect the eye.  There are a number of potential eye related side effects with isotretinoin. These include abnormal meibomian gland secretion, blepharoconjunctivitis, corneal opacities, decreased dark adaptation/reduced night vision, decreased tolerance to contact lens, decreased vision, increased tear osmolarity, keratitis, meibomian gland atrophy, myopia, ocular discomfort, ocular sicca, photophobia, pseudotumor cerebri, anterior segment inflammation, dry eye syndrome, altered refraction, photosensitivity and papilledema. Most of the adverse effects of isotretinoin are reversible on discontinuation of isotretinoin therapy. The exceptions are loss of dark adaptation which may be permanent and some dry eye issues which may either be permanent or take a long time to resolve for some patients.  Generally these issues occur when high doses are used. Isotretinoin is contraindicated for LASIK and PRK and patients are currently required to wait six months after stopping before laser refractive surgery and should not restart treatment in the early postoperative period.

Are dermatologists familiar with isotretinoin side effects?

A study from Egypt set out to evaluate if practicing dermatologists are familiar with many of the isotretinoin eye related side effects.

111 dermatologists were surveyed. Regarding eye side effects, most dermatologist 105 of 111 (94.6%) dermatologists reported some knowledge although 5.4 % did not know about them. 90.1% of dermatologists informed their patients about ocular dryness and keratitis. 25.2 % of dermatologists were unaware that isotretinoin use could be associated with intolerance to contact lenses. 18.9 % of dermatologists rarely screen patients about refractive surgery and 60 % did not consistently warn patients them about the importance of avoiding any such surgery fro 6 months after isotretinoin use.

Conclusion

This was an interesting study which captures some of the important knowledge gaps in prescribing and counselling patients about isotretinoin use. It is important to counsel about the contraindications around laser eye surgery and to discuss the poor tolerance to contact lenses.

REFERENCE

Elshafie M et al. Dermatologists' Knowledge and Attitude Toward Isotretinoin Ocular Side Effects in Egypt. Clin Cosmet Investig Dermatol. 2021 Sep 18;14:1295-1301.