Accutane (isotretinoin) is one of the most widely used treatments for severe acne. Each year over 2 million patients take accutane for a fast reliable acne treatment.
While accutane has proven to be an effective acne medication, researchers have found a number of troublesome side effects related to the eyes. Most notably, some patients experience dry eyes on accutane.
While the discovery of dry eyes on accutane may not dissuade patients from taking the drug, they should understand the effect the medication has on their eyes and body.
Accutane is the brand name for the drug isotretinoin. The drug was patented in 1969 and approved for market in 1982. The oral medication is used to treat severe acne that has proved resistant to other treatments.
Many dermatologists consider it the most effective medication for treatment-resistant acne. Around 50% of people who use it report clear skin and no longer need additional acne treatment.
Accutane belongs to a class of drugs called “retinoids”, which share similarities with vitamin A. The medication works by shrinking a patient’s sebaceous glands, which are responsible for producing oil.
These shrunken glands slow down oil production which reduces build-up, pore clogging, and inflammation that causes acne to break out.
When the chemicals in accutane enter the bloodstream they reduce oil and lubrication throughout the body. This includes the meibomian glands in the eyelid, which are responsible for producing oil for tears.
These glands keep the eye hydrated and produce oil which coats tears and prevents them from evaporating. Suppression in the meibomian glands can cause tears to evaporate before they lubricate a patient's eye, causing dry and irritated eyes.
Dry eye occurs when the eye does not create enough tears or when the eyes don’t produce the right type of tears or tear film.
Common dry eye symptoms include:
A stinging or burning sensation in the eyes
A scratchy or gritty feeling like there is something in the eye
Pus or mucus around the eye
Red or irritated eyes
Discomfort wearing contact lenses
Excess tears in the eyes
In addition to dry eyes on accutane, the medication has been linked to a number of other eye-related conditions.
Contact lens intolerance
Prior to receiving an accutane prescription most dermatologists will suggest patients have an eye exam. The goal of this examination is to test patients' tear production and make sure they aren’t prone to dry eye before receiving their prescription.
If a patient is at risk for dry eyes, the eye doctor may recommend a different medication or suggest ways to manage dry eye while on the medication.
If a patient develops dry eyes on accutane, the eye doctor may recommend a number of treatments. The most common are artificial tears. Artificial tears lubricate the eye and can provide quick relief for patients experiencing dry eye related discomfort.
Ophthalmologist’s may also suggest patients block tear ducts with gel or silicone plugs. This keeps eyes lubricated by making tears stay in longer. Other dry eye treatments include: placing a warm compression over the affected eye, massaging eyelids, or using eyelid cleaners.
Certain lifestyle changes can also reduce dry eye symptoms. These include avoiding smoke & wind, using a humidifier, cutting down screen time, drinking water, and getting more sleep.
If a patient develops severe dry eyes on accutane, their doctor may recommend they cease taking the medication. Ideally, these severe symptoms will be avoided in the pre-screening prior to receiving a prescription.
If a patient stops taking accutane their dry eye will typically clear up in a few weeks with no long term side effects.
However, a study published in Optometry and Vision Science (2015) found that in very rare cases patients may suffer from permanent meibomian gland dysfunction after completing their treatment.
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