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  • Writer's pictureDr. Zimski

Accutane and Meibomian Gland Dysfunction: A Cause Of Dry Eye Syndrome?

Acne is a common dermatologic condition associated with overactive sebaceous glands. These glands produce sebum, a sticky, oily substance that contains lipids that help moisturize and protect the skin. Sebum can also clog pores and cause acne. It affects all age groups but is most common during adolescence. 

Accutane and Meibomian Gland Dysfunction: A Cause Of Dry Eye Syndrome?

Accutane: What It Does

Accutane (isotretinoin) is the most effective medication for acne that is resistant to other medications. It reduces the secretion of sebum and the size of the sebaceous glands by as much as 90 percent and normalizes the keratinization processes in the ducts of the sebaceous glands. 

While highly effective for treating severe acne, it can lead to a range of side effects.

Ocular symptoms caused by isotretinoin are a growing concern, as the meibomian glands (MG) are large, specially differentiated sebaceous gland and oral administration of isotretinoin can lead to Meibomian Gland Dysfunction (MGD) resulting in evaporative dry eye.

Let’s take a look at the relationship between Accutane and MGD and at the underlying mechanisms, symptoms, and potential management strategies for those affected.

What is Meibomian Gland Dysfunction?

The meibomian glands, located in the eyelids, secrete oils that form a critical part of the tear film, preventing rapid evaporation of tears. Meibomian gland dysfunction occurs when these glands become blocked or their oil secretion is abnormal, leading to an unstable tear film and symptoms of dry eye. When tears evaporate too quickly, the tear break-up time (TBUT) is decreased.  Normal is considered greater than 10 seconds.  

A study in the European Journal of Ophthalmology examined patients prior to starting Accutane, during the course of treatment and for 12 months after they finished treatment.  They found that dry eye symptoms worsened throughout treatment which correlated with meibomian gland abnormalities and tear film layer deterioration. They gradually began to normalize after treatment was discontinued, however, 12 months after the end of treatment, scores remained worse than baseline. 

88 patients were followed monthly for a year after discontinuation of treatment with meibomian gland imaging, evaluation of meibum quality and tear break-up time.  Prior to this study, there was controversy as to whether meibomian gland abnormalities persisted after the treatment was discontinued, but this study clearly showed that accutane may cause permanent damage to the meibomian glands. 

Accutane and Meibomian Gland Dysfunction: A Cause Behind Dry Eye Syndrome?

Symptoms of MGD and Dry Eye Syndrome

Patients on Accutane may experience dry eye symptoms that include:

  • Persistent dryness

  • Redness and irritation

  • Sensation of grittiness or foreign body in the eye

  • Sensitivity to light

  • Blurred vision

These symptoms can significantly affect the quality of life, making it essential to recognize and address them promptly.

Diagnosing MGD involves a thorough eye examination, including tests like:

  • Meibography: Imaging to assess gland structure.

  • Tear Break-Up Time (TBUT): Measures tear film stability.

  • Meibomian gland function: expressibility and quality of meibum

Treating Dry Eyes In Accutane Users

It is important for Accutane users to be evaluated by ophthalmologists if they experience dry eye symptoms as early treatment can not only improve symptoms, but also improve long term outcomes.  

Long-Term Outlook for Accutane Users

For some patients, the effects of Accutane on the Meibomian glands and dry eye symptoms may improve after discontinuing the medication. However, some individuals may experience long-lasting or even permanent changes. Early intervention and consistent management are crucial to mitigate the impact on eye health.

While Accutane is a highly effective treatment for severe acne, its potential impact on Meibomian Gland Dysfunction and dry eye syndrome cannot be overlooked. Understanding the connection between Accutane and MGD is vital for both patients and healthcare providers.

By recognizing the symptoms early and employing appropriate management strategies, you can minimize discomfort and maintain better ocular health.


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