Isotretinoin and Keratoconus: Examining the Potential Link
There is no established causal relationship between isotretinoin use and the development of keratoconus based on current clinical guidelines and available evidence. While isotretinoin is associated with various ocular side effects, keratoconus is not specifically mentioned as a known complication in recent dermatology or ophthalmology guidelines.
Documented Ocular Effects of Isotretinoin
Common Ocular Side Effects
- Dry eye (most common ocular side effect) 1
- Xerophthalmia (dry eyes)
- Conjunctivitis 2
- Ocular surface changes 3
Rare Ocular Complications
- Night blindness (reported but causal relationship not clearly established) 4
- Isolated case reports of cataract formation 5
- Corneal epithelial thickening and stromal thinning 3
Clinical Implications for Patient Management
Monitoring Recommendations
Pre-treatment assessment:
- Basic ocular history
- Inquiry about contact lens use (patients with conditions that impair corneal wetting should be counseled about potential side effects) 2
During treatment:
- Monitor for symptoms of dry eye, eye sensitivity, and vision changes
- Consider prophylactic use of ocular lubricants, especially in patients with pre-existing dry eye or contact lens wearers 2
Risk Mitigation Strategies
- Consider omega-3 fatty acid supplementation (1g/day) during isotretinoin therapy to reduce mucocutaneous side effects, which may include ocular manifestations 6
- Temporary discontinuation of contact lens wear may be necessary during treatment
- Prompt referral to ophthalmology for any significant visual changes or persistent ocular symptoms
Important Considerations for Special Populations
Refractive Surgery Patients
- Isotretinoin use should be disclosed before refractive surgery procedures
- Case reports indicate potential for post-surgical interface alterations in patients on isotretinoin 3
- Current guidelines suggest delaying elective procedures for 6-12 months after isotretinoin discontinuation when possible 2
Long-term Safety Profile
A long-term safety study with a mean follow-up of 4.9 years (range 2-12 years) found dry eye syndrome to be an infrequent but probable long-term side effect of isotretinoin, but did not report keratoconus as a complication 7. Most ocular side effects resolve following isotretinoin discontinuation with standard treatment courses 2.
Clinical Takeaway
While isotretinoin has well-documented ocular side effects, primarily affecting the ocular surface and tear film, there is no evidence in current clinical guidelines or research literature establishing a causal link between isotretinoin use and keratoconus. Clinicians should continue to monitor for common ocular side effects and refer patients with persistent or concerning visual symptoms for ophthalmologic evaluation.