Permanent Dry Eye After Accutane - A Warning

Recently I've seen quite a few posts regarding dry eye and accutane. As somebody who took 2 full courses of accutane and developed severe dry eye, I thought I'd make a post to share my experience and what I've learned. I'm not a doctor or a research scientist so take this with a grain of salt.

Many studies have shown that accutane can cause dry eye during and after treatment. The reason this happens is because accutane targets secretory glands and overloads them with vitamin A which basically kills the oil-producing cells and atrophies the gland. This is how accutane treats acne, it makes your skin permanently produce less oil. Our eyes have very similar secretory glands called meibomian glands that secret oils which prevent tears from evaporating. Accutane is a systemic drug, and so it also atrophies these meibomian glands. Once enough of those cells die and glands shrink to a certain threshold, it triggers symptomatic dry eye or meibomian gland dysfunction. A lot of times the damage accutane causes during treatment does not cross this threshold so patients don't experience symptoms, but meibomian glands atrophy as we age, so you see cases of people getting dry eye years after accutane.

As for how dry eye can affect you, it depends on your severity. It can range from barely noticeable to constant life-altering pain. Personally, I have severe dry eye and am no longer able to play video games, watch TV, or even go outside due to the pain caused by wind and air conditioning. I know many people in support groups who have had to leave their careers, studies, and previous lifestyle due to this disease. For more anecdotes on how dry eye affects people's lives check out r/dryeyes.

Treatments for dry eye do exist, but the damage to the meibomian glands is irreversible with modern medicine and thus there is no cure. Effectiveness of treatments depends on severity but generally do not remove the pain, only reduce it to an extent. Dry eye is also not recognized by insurance worldwide and modern treatments cost thousands of dollars annually, all out of pocket.

This post isn't intended to be medical advice and it's not all doom and gloom. Most accutane patients do not develop permanent dry eye from what I've seen. Whether you want to take the risk is up to you and your doctor, but you should know that this seemingly harmless but potentially life-altering disease is a possibility.

Sources: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8976919/ https://pubmed.ncbi.nlm.nih.gov/26154692/ https://escholarship.org/uc/item/3mm9k54s https://link.springer.com/article/10.1007/s10792-021-02205-1 https://www.notadryeye.org/all-about-dry-eye-syndrome/causes-of-dry-eye-syndrome-and-related-diseases/accutane-isotretinoin/ https://youtu.be/doJDLqjakJQ