Night blindness precipitated by isotretinoin in the setting of hypovitaminosis A

Authors: Welsh, Belinda M¹; Smith, Arnold L²; Elder, James E³; Varigos, George A⁴

Source: Australasian Journal of Dermatology, Volume 40, Number 4, November 1999 , pp. 208-210(3)

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Abstract:

SUMMARY

A 16-year-old male developed night blindness 2 weeks after starting isotretinoin at a dose of 20 mg per day for cystic acne. He also had cystic fibrosis, complicated by hepatic cirrhosis. Despite long-term oral vitamin A supplementation, serum vitamin A levels were found to be 0.3 μmol/L (normal range 0.9-2.5 μmol/L). Oral vitamin A replacement was instituted with resolution of his visual symptoms in 6 months. Isotretinoin therapy was successfully continued with no deterioration in liver function. Isotretinoin has been reported to cause deterioration in night vision. In vitro evidence suggests isotretinoin may interfere with the processing of endogenous vitamin A in the retina. This case highlights the need for careful monitoring of serum vitamin A status in patients with malabsorptive states on isotretinoin therapy.

Keywords: 13-cis retinoic acid; cystic fibrosis; electroretinogram; retina; retinoids; vitamin A

Document Type: Research article

DOI: http://dx.doi.org/10.1046/j.1440-0960.1999.00363.x

Affiliations: 1: Department of Dermatology, St Vincent's Hospital and Departments of 2: Gastroenterology and Nutrition, 3: Ophthalmology and 4: Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia

Publication date: 1999-11-01