Efficacy of omega-3 fatty acids and punctal plugs in the prevention of isotretinoin-associated ocular surface disease

Abstract

Purpose: To investigate the effects of omega-3 fatty acids and punctal plugs on tear film and ocular surface parameters in patients receiving systemic isotretinoin therapy. Methods: This is a prospective randomized study that included 180 eyes of 90 patients who had systemic isotretinoin therapy (120–150 mg/kg for at least 4–6 months). Exclusion criteria: DED according to the diagnostic criteria of TFOS DEWS II. Patients were assigned into three groups; (1) O3FAs/PPs group: A soft preloaded silicone plug was inserted in the inferior punctum of both eyes and received oral O3FAs two capsules twice daily total daily dose of 1040 mg/day for 6 months. (2) PPs group: A soft preloaded silicone plug was inserted in the inferior punctum of both eyes and received oral placebo. (3) Isotretinoin group: No intervention was done. At baseline, 1 week, 1, 3, and 6 months of study, Ocular surface evaluation tests were done in following order: OSDI, tear osmolarity, Schirmer’s I test, TBUT, ocular surface staining score, and meibomian gland expression. Primary outcome measures: The changes in measurement of ocular surface evaluation tests including ocular surface disease index (OSDI), tear film breakup time (TFBUT), corneal staining, tear osmolarity, and meibomian gland expression at 6 months. Results: There are significant changes between all groups at 6 months follow-up. The ocular surface parameters were better for the PPs and O3FAs/PPs groups than the isotretinoin group. The isotretinoin group showed worsening of ocular surface parameters including a significant decrease of FTBUT and an increase of OSDI score, corneal staining score, tear osmolarity, and meibomian expression score. There was no significant difference in ST1 throughout the whole study in all groups. At 6 months follow-up, there were no statistically significant differences between PPs and O3FAs/PPs groups except meibomian expression score which showed a significant increase in PPs group. Conclusion: Our cohort highlights the beneficial effects of the combination of O3FAs supplementation with PPs in the prevention of isotretinoin-associated OSD in this sample study.

Isotretinoin Impairs the Secretory Function of Meibomian Gland Via the PPARγ Signaling Pathway

“… 51 , 52 Other literature shows no significant change in tear secretion. 6 , 53 – 56 Barbosa et al 57 reported a white female with lacrimal gland agenesis, and after excluding Sjogren's syndrome, a review of the medical history revealed a possible association with Isotretinoin use. But in previous animal studies, rabbits were given doses five to 10 times higher than those used clinically for more than five months, there were no significant changes in tear secretion compared with the control group.…”

The Effects of Isotretinoin on The Menstrual Cycle: A Cross-Sectional Study

“…These findings are similar to the findings of a recent study carried out by Akpolat [ 38 ]. It is essential to have new guidelines to compensate for these possible adverse effects, as some studies had investigated measurements to avoid other adverse effects such as isotretinoin-associated ocular surface disease and teratogenicity [ 39 , 40 ].…”

Update on Dry Eye Disease Treatment: Evidence From Randomized Controlled Trials

“…Two key essential fatty acids (EFAs) are the omega-3 (O-3) and omega-6 (O-6) fatty acids, which compete for the enzymes that regulate their metabolism, to produce eicosanoids that can modulate systemic inflammation (Table 4). [58][59][60][61][62][63][64][65][66][67] Omega-3 essential polyunsaturated fatty acids have a broad range of systemic anti-inflammatory effects and can inhibit the production of proinflammatory cytokines and prevent T-lymphocyte proliferation. 60 A handful of RCTs have sought to determine the efficacy of O-3 EFA supplementation in DED.…”