The Effect of Oral Isotretinoin Therapy on Meibomian Gland Characteristics in Patients with Acne Vulgaris

Aleksandra Zakrzewska; Marta P Wiącek; Sylwia Słuczanowska-Głąbowska; Krzysztof Safranow; Anna Machalińska

doi:10.1007/s40123-023-00737-6

The Effect of Oral Isotretinoin Therapy on Meibomian Gland Characteristics in Patients with Acne Vulgaris

Ophthalmol Ther. 2023 Aug;12(4):2187-2197. doi: 10.1007/s40123-023-00737-6. Epub 2023 Jun 10.

Authors

Aleksandra Zakrzewska¹, Marta P Wiącek¹, Sylwia Słuczanowska-Głąbowska², Krzysztof Safranow³, Anna Machalińska⁴

Affiliations

¹ First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111, Szczecin, Poland.
² Department of Physiology, Pomeranian Medical University, Al. Powst. Wlkp. 72, 70-111, Szczecin, Poland.
³ Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Al. Powst. Wlkp. 72, 70-111, Szczecin, Poland.
⁴ First Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111, Szczecin, Poland. anna.machalinska@pum.edu.pl.

Abstract

Introduction: The aim of the study was to determine the effect of oral isotretinoin therapy on the functional and morphological condition of the anterior segment of the eye, with particular emphasis on the meibomian glands.

Methods: Twenty-four patients (48 eyes) with a diagnosis of acne vulgaris were involved in the survey. All patients underwent a thorough ophthalmological examination at three time points: before therapy, 3 months after the start of therapy, and 1 month after the completion of isotretinoin therapy. The physical examination included the following elements: blink rate, analysis of the lid margin abnormality score (LAS), tear film break-up time (TFBUT) and Schirmer's test, meibomian gland loss (MGL), and the evaluation of the meibum quality score (MQS) and meibum expressibility score (MES). Additionally, the total score of an ocular surface disease index (OSDI) questionnaire was analysed.

Results: In comparison with pretreatment values, significant increases in OSDI during and after the treatment (p = 0.003 and p = 0.004, respectively) were observed. Substantial deterioration during the treatment was observed for MGL (p < 0.0001), MQS (p < 0.001) and LAS (p < 0.0001), while an improvement in those parameters after isotretinoin cessation was observed (p = 0.006, p = 0.02 and p = 0.0003, respectively). The frequency of using artificial eye drops was positively associated with MGL during (Spearman's rank correlation coefficient (Rs) = + 0.31; p = 0.03) and after the cessation of the therapy (Rs = + 0.28; p = 0.04). Meibomian gland atrophy correlated significantly with MQS during (Rs = + 0.29; p = 0.04) and after treatment (Rs = + 0.38; p = 0.008). The decrease in TFBUT values correlated with increased LAS (Rs = - 0.31; p = 0.03) during the course of isotretinoin usage. We found no changes in Schirmer's test or blink rates.

Conclusion: Isotretinoin therapy leads to increased ocular complaints related to lipid tear film component dysfunction. This is due to reversible changes in meibomian gland morphology and function observed during drug usage.

Keywords: Acne vulgaris; Dry eye; Isotretinoin; Lid margin abnormality score; Meibography; Meibomian gland; Meibum expressibility score; Meibum quality score; Ocular surface disease index.