Xerophthalmia occurs in one third of patients during isotretinoin therapy and is caused by decreased meibomian gland secrection, leading to an altered composition of the tear film and shortening of the tear film break-up time. This may lead to blepharoconjunctivitis, exposure keratitis, and corneal ulceration in extreme cases. Some patients may also develop a contact lens intolerance. Application of artificial tears several times a day can help alleviate these symptoms. Other ophthalmologic toxicities from retinoids include corneal opacities, decreased night vision (as a result of interference with steps in the rhodopsin cycle), transient acute myopia, papilledema, and cataracts. Rarely, dry eye syndrome and decreased night vision have been reported to persist after discontinuation of therapy. Etretinate and acitretin use have been shown to cause many of the same ocular side effects as isotretinoin therapy. However, isotretinoin seems to have a greater ability to suppress meibomian gland secretion (Brecher and Orlow 2003, Ellis and Krach 2001, Katz et al. 1999, Orfanos et al. 1987, Peck and DiGiovanna 1999).
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