Oral isotretinoin for acne vulgaris side effects on the ocular surface: Hyaluronic acid and galacto-xyloglucan as treatment for dry eye disease signs and symptoms

Abstract

The purpose was to assess the efficacy of 0.4% hyaluronic acid and 0.2% galacto-xyloglucan on the subjective symptoms of dry eye disease and invasive and non-invasive tear film signs in oral isotretinoin for acne vulgaris treatment. A prospective, longitudinal, single-blind, clinical study was performed in oral isotretinoin for the acne vulgaris consumer population. Subjective dry eye disease questionnaires and invasive and non-invasive tear film assessments were reported prior to and after 6 weeks of hyaluronic acid with galacto-xyloglucan (HA-GX) treatment vs. hyaluronic acid alone (HA). Participants in the HA-GX group reported a higher decrease in the ocular surface disease index (17.01 ± 11.36 score points) compared to the variation in participants in the HA group (11.61 ± 11.18 score points). Standard patient evaluation of eye dryness also decreased more in participants in the HA-GX group (4.06 ± 5.50 score points) than in participants who received HA alone (0.70 ± 3.16). Regarding non-invasive break-up time (NIBUT), participants in the HA-GX group first NIBUT achieved an increase of 1.75 ± 1.16 s while participants in the HA-alone group demonstrated an increase of only 0.54 ± 1.01 s. The HA-GX group mean NIBUT increased by of 3.72 ± 5.69 s; however, the value for the HA-alone group was 2.19 ± 5.26 s. Hyaluronic acid in combination with galacto-xyloglucan significantly decreased limbal and bulbar conjunctival redness classification and SPEED test outcomes. The inclusion of galacto-xyloglucan also increased BUT and mean NIBUT values compared to those obtained with hyaluronic acid alone.

Keywords: acne vulgaris; dry eye disease; eyedrops; galacto xyloglucan; hyaluronic acid; isotretinoin; tear film.

FIGURE 1

Meibomian gland dysfunction (MGD) distribution among the sample. (A) Superior eye lid with Grade 1 dysfunction (22.3% of MGD), (B) inferior eye lid with Grade 1 dysfunction (23.7% of MGD), (C) superior eye lid with Grade 2 dysfunction (30.1% of MGD), (D) inferior eye lid with Grade 2 dysfunction (39.3% of MGD). (E) Superior eye lid with Grade 3 dysfunction (57.1% of MGD), (F) inferior eye lid with Grade 3 dysfunction (53.7% of MGD).

FIGURE 2

Box and plot graph differences before and after treatment with 0.40% hyaluronic acid with 0.20% galacto-xyloglucan (HA-GX) and 0.40% hyaluronic acid (HA). (A) Break up time differences before (striped, green) and after (striped, red) eyedrop treatment. (B) Mean non-invasive break-up time (NIBUT) before (striped, green) and after (striped, red) eyedrop treatment. (C) Conjunctival redness before (striped, green) and after (striped, red) eyedrop treatment and (D). Standard patient evaluation eye disease (SPEED) before (striped, green) and after (striped, red) eyedrop treatment.