Isotretinoin-Induced Meibomian Gland Dysfunction: Rationale for Proactive Clinical Surveillance

Abstract

Purpose:

We synthesized the current evidence on isotretinoin-induced Meibomian gland dysfunction (MGD), including underlying mechanisms, clinical manifestations, risk factors, management strategies, and the need for updated screening recommendations.

Methods:

The review was conducted during November 2025, covering multiple databases including Semantic Scholar, PubMed, and others. The search yielded 1,046 records; after eligibility assessment, 53 studies were included. Clinical, preclinical, and review articles, as well as clinical guidelines were considered if they met predefined quality standards.

Results:

Isotretinoin significantly impairs Meibomian gland function by suppressing PPARγ signalling, leading to reduced lipid secretion, glandular inflammation, and atrophy. These effects often precede overt symptoms, complicating early diagnosis. Risk factors include prolonged or high-dose therapy, pre-existing ocular surface disease, contact lens wear, and dermatologic or systemic comorbidities. Clinical manifestations range from mild dry eye symptoms to persistent ocular surface damage. Current management is largely palliative, and there is no validated therapy for reversing gland atrophy. Despite mounting evidence, existing clinical guidelines do not recommend ophthalmologic screening, potentially delaying diagnosis and intervention.

Conclusion:

Isotretinoin-induced MGD is a clinically significant and underrecognized adverse effect. The absence of routine ophthalmological screening and standardized monitoring protocols leaves high-risk patients vulnerable to irreversible gland damage. Proactive surveillance, structured prevention, and individualized management are essential to minimize long-term ocular complications. Among all strategies, infrared meibography may serve as an objective, non-invasive tool to monitor isotretinoin-induced Meibomian gland damage, guiding early intervention and treatment decisions. Further research is needed to establish optimal screening strategies and explore effective preventive and restorative therapies.