The only study that may consistently show the effect of isotretinoin on the optic nerve head, since it evaluates the optic nerve head according to their size.

Isotretinoin has a number of neurological and ocular side effects, but its effect on the optic nerve has not been demonstrated.

To investigate the effect of oral isotretinoin therapy on the peripapillary retinal nerve fibre layer thickness (RNFL) in patients with small optic disc area using optical coherence tomography (OCT).

This retrospective study included 55 patients taking 40 mg/day oral isotretinoin. The patients were grouped according to optic disc area. Patients with small optic disc area were included in group 1 and the others in group 2. RNFL thickness was measured by spectral domain OCT before the treatment, at the third month of the treatment, and at the third month after treatment.

RNFL increased significantly in group1 in the third month of treatment compared to that before the treatment (P < 0.001); no significant change was observed in group 2 (P < 0.244).

Oral isotretinoin treatment may be effective in patients with small optic nerve head. The presence of a small optic disc may increase the risk of adverse effects such as decreased dark adaptation, reduced vision, headache, or photophobia.

Evaluating the optic disc size before initiation of oral isotretinoin treatment may assist in planning patient treatment.

Optical coherence tomography

Retinal nerve thickness

Optic nerve

Isotretinoin

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