Abnormal night vision with isotretinoin therapy for acne.

TLDR: A 19-year-old trainee RAF navigator who developed abnormal night vision during isotretinoin therapy, given in a dose of 70 mg daily for acne vulgaris, complained of blurred vision, photophobia and decreased night vision, and electrophysiology showed little recovery in retinal function.

Abstract: SIR, we would like to report a case of a 19-year-old trainee RAF navigator who developed abnormal night vision during isotretinoin therapy, given in a dose of 70 mg daily for acne vulgaris. He developed the common side-effects of dry skin and cheilitis, but after 3 weeks of treatment he complained of blurred vision, photophobia and decreased night vision. His visual acuities were reduced to 6/18 in the right eye and 6/12 in the left eye. Refraction showed 1-5 dioptres of myopia in both eyes but appropriate correction of this produced 6/4 vision in both eyes. Blepharoconjunctivitis was noted bilaterally but otherwise ocular examination was unremarkable, and in particular both fundi and optic discs were normal. There was no family history or ophthalmic evidence of retinitis pigmentosa. Isotretinoin therapy was withdrawn immediately and the decreased night vision was investigated using electrophysiology. Visual evoked potentials (VEP) were normal but the scotopic electro-retinogram (ERG) and the electro-oculogram (EOG) were abnormal, suggesting poor retinal function in dark adapted conditions. At 2 weeks followup his unaided vision had returned to normal with no significant refractive error. However, at 3 months follow-up the patient still complained of poor night vision and the ERG and EOG showed little recovery in retinal function. At the last follow-up appointment, 9 months after withdrawal of isotretinoin, the patient subjectively felt that his night vision was still poor.