Accutane and Dry Eyes: Understanding the Cause and How to Protect Your Eyes

Isotretinoin, commonly known by the brand name Accutane, is a powerful medication used to treat severe acne. While highly effective, it's well-known for its range of side effects – one of the most common and often overlooked being dry eye disease. For patients on Accutane, managing eye health becomes critical, and early intervention can make a lasting difference.

Why Accutane Causes Dry Eyes

Accutane is a retinoid, a derivative of vitamin A, that works by drastically reducing sebum production from the skin’s oil glands. This is how it helps reduce acne and other skin problems.

However, it doesn’t just affect the skin. It also impacts other oil producing glands, such as meibomian glands, which are specialized oil glands located along the eyelid margins. These glands secrete meibum, an oily layer essential for a stable tear film.

When Accutane reduces meibomian gland activity:

• The lipid layer of the tear film becomes thinner.
• Tears evaporate faster, leading to evaporative dry eye.
• Patients experience symptoms like burning, stinging, grittiness, light sensitivity, and blurry vision.

In some individuals, this gland suppression leads to gland atrophy, where the glands shrink or drop out entirely on imaging, a process that may be irreversible if not addressed promptly.

So, if your son or daughter is using accutane to prevent or reduce acne, they should also be focused on eye and eyelid health protocols - particularly dry eye prevention ones like eyelid hygiene and warm compresses. Many dermatologists fail to mention this side effect, but it can cause lasting damage. So, it is essential for your child to take preventative measures.

The Serious Risk: Meibomian Gland Dysfunction (MGD) and Gland Loss

A major concern with Accutane-induced dry eye is that it doesn't just make the eyes temporarily dry. It can structurally damage the glands responsible for long-term tear stability.

• Meibomian gland dysfunction (MGD) is a progressive condition where the glands become blocked, inflamed, or deteriorated.
• Prolonged gland inactivity can lead to permanent gland dropout, meaning they will no longer produce oil even after Accutane is stopped.
• Imaging with meibography can sometimes show significant gland atrophy in Accutane users, even months or years after treatment.

This makes early prevention and proactive eyelid care vital for anyone on or considering Accutane.

Pro Tip: Look for an eye doctor that can do a meibography before your child starts Accutane, and then during their use. This will help ensure that you are taking proactive steps to prevent gland loss.

Eyelid Hygiene: A Simple But Effective Defense

Routine eyelid hygiene helps maintain gland health and prevent blockages:

• Lid scrubs or gentle cleansers like hypochlorous acid sprays, a tea tree oil or coconut oil foaming cleanser, or even eyelid wipes with these formulas should be used.
• Use a clean cotton pad, sponge, or eyelid wipe to gently clean along the lash line daily.
• These steps help reduce the risk of bacterial overgrowth and keep the gland orifices open.

This is particularly needed during Accutane treatment to maximize good gland flow and high quality meibum.

Warm Compresses: Encouraging Healthy Oil Flow

Warm compresses are another essential step to combat gland stagnation:

• Apply a warm compress (not hot) over closed eyes for 5–10 minutes daily.
• Use microwaveable eye masks or warm, moist washcloths to help soften the hardened oils in the meibomian glands.
• After warming, gently massage the eyelid margins to express the oil and encourage flow.

This encourages gland function and helps maintain a healthy tear film, reducing the impact of Accutane on ocular surface health.

Final Thoughts: Prevention Is Power

Dry eyes from Accutane are more than a nuisance—they can be a sign of deeper, long-term gland damage. While not everyone will develop permanent gland loss, the risk is real, especially with extended use or pre-existing dry eye symptoms.

If you're planning to start Accutane or are currently taking it:

• Talk to your dermatologist and an eye care provider before or early in the treatment.
• Begin eyelid hygiene and warm compresses from the start - not just when symptoms appear.
• If symptoms persist, consider a dry eye evaluation with imaging to assess meibomian gland health.

Dry eye doesn’t have to be the price you pay for clear skin. With a little awareness and consistent care, you can protect both your vision and your comfort for the long term.

Prevention starts with daily care. Explore Peeq’s eyelid hygiene essentials to support healthy glands while on Accutane.