Tolerance to Systemic Isotretinoin Therapy in Two Patients Using Highly Wettable Contact Lenses

Purpose. Numerous ocular side effects have been reported with the use of systemic isotretinoin therapy. Herein, we presented two contact lens user patients who did not have contact lens intolerance during systemic isotretinoin therapy. Methods. 25-year-old male and 20-year-old female patients with severe acne vulgaris who were using highly wettable silicone hydrogel contact lenses which increase tear film stability were examined. Tear film function tests including Schirmer tests and tear break up time (TBUT) test and ocular surface staining with fluorescein were done. Subjective ocular complaints were scored with ocular surface disease index (OSDI) questionnaire. Patients were followed up monthly and examinations were repeated at each visit. Results. Both patients completed the therapy after a cumulative dose of 140？mg/kg isotretinoin in 6 months. The OSDI score and tear film function tests before and after treatment were all within normal limits. Discussion. Highly wettable contact lenses that provide increase in the tear film stability may be used during systemic retinoid therapy under close followups. Although isotretinoin affects ocular glands, the differences between tolerances to this retinoid therapy need to be investigated in larger patient groups using contact lenses. 1. Introduction Isotretinoin is a synthetic vitamin A derivative (13-cis retinoic acid) which is widely prescribed for resistant acne vulgaris. Numerous ocular side effects have been reported with the drug affecting the eyelids, cornea, lens, optic nerve, and retina [1]. According to WHO Causality Assessment Guide “ocular sicca, blepharoconjunctivitis, and decreased tolerance to contact lens wear” were reported as “certain” adverse effects among ocular adverse effects of isotretinoin [1]. This report describes two cases who continued to use highly wettable silicone hydrogel contact lenses during systemic isotretinoin therapy without any dry eye complaint, ocular adverse effect, and any need of artificial tears. 2. Cases 2.1. Clinical Features Case 1 was a 25-year-old male patient with nodulocystic acne who was consulted from dermatology outpatient clinic before initiation of oral isotretinoin treatment. He has been using contact lenses (Acuvue Oasys with hydraclear plus) for seven years. He was a computer engineer working with computer for about 8 to 10 hours daily. Case 2 was a 20-year-old female patient with resistant nodulocystic acne who was planned to be put on systemic isotretinoin treatment. She was a student at university. She has been using contact lenses (Acuvue Oasys