Guidelines issued for managing ocular effects of acne drug

PORTLAND, Ore. — Ocular side effects of isotretinoin use can take many forms. A group of ophthalmologists here has issued guidelines for ophthalmic management of patients using the drug.

The acne medication Accutane (isotretinoin, Roche Pharmaceuticals) can cause ocular side effects including abnormal meibomian gland secretion, blepharoconjunctivitis, corneal opacities, decreased dark adaptation, decreased tolerance to contact lenses, decreased vision, increased tear osmolarity, keratitis, meibomian gland atrophy, myopia, ocular discomfort, ocular sicca, photophobia and teratogenic ocular abnormalities.

F.T. Fraunfelder, MD, of the Casey Eye Institute, and colleagues evaluated 1,741 spontaneous reports of 2,379 ocular adverse events possibly associated with use of isotretinoin. The researchers identified 38 ocular abnormalities as "certain" to have resulted from the use of the acne drug using the criteria from the World Health Organization Causality Assessment Guide of Suspected Adverse Reactions.

The authors suggested that if patients are already on isotretinoin when first referred for ocular complaints, ophthalmologists should ascertain the onset of symptoms and consider discontinuing the drug if the symptoms are progressive or persistent.

"Because most cases are transitory, these are not necessarily an indication for discontinuing the drug. However, if they persist, closer monitoring and further testing are recommended," the researchers said.

Ophthalmologists should also consider testing for ocular sicca and color vision and should view the optic nerve for signs of edema. The researchers recommended discontinuing isotretinoin if any of the following occur: pseudotumor cerebri, optic neuritis, night blindness, decreased color vision or significant ocular sicca. Informed consent should be obtained if the medication is restarted.

Complete findings are reported in the September issue of the American Journal of Ophthalmology.