Study Links Topical Retinoids to Increased Ocular Discomfort

The review analyzed data from 89 studies involving over 10,000 participants, of which 55 studies were included in the meta-analysis. It was noted that these topical products, especially prescription-strength retinoids, are associated with higher odds of ocular pain, dryness, and burning sensations. Retinoids function by downregulating sebum production, which can interfere with the activity of the meibomian glands, known for their role in maintaining tear production.

Researchers conducted a comprehensive search in databases such as PubMed and Scopus from their inception through August 2025 for studies evaluating topical vitamin A applications on the ocular surface, eyelids, or periorbital areas. The findings highlight that topical vitamin A derivatives significantly increase the odds of adverse effects compared to non-vitamin A controls. The strongest association was found with ocular pain, which had an odds ratio of 6.37, followed by dryness (OR: 2.69) and burning (OR: 2.44). Other symptoms included scaling (OR: 1.98), itchiness (OR: 1.78), redness (OR: 1.29), and skin damage (OR: 1.52).

Prescription-strength retinoids posed a greater risk than over-the-counter formulations, with prescription products linked to 1.74 times the odds of any harm. In contrast, serious adverse events were rare and not significantly heightened.

Kaleb Abbott, OD, the lead author of the study from the University of Colorado School of Medicine, explained that while topical vitamin A can benefit numerous skin conditions, its application in the periorbital area may unintentionally disrupt meibomian gland function. He emphasized that the cornea's sensitivity is much greater than that of the skin, leading to potential ocular surface disruption and dry eye symptoms when meibomian gland function is altered.

Abbott noted the importance of educating patients about the ocular risks associated with over-the-counter retinol products, often applied for cosmetic reasons. He stressed that a thorough cosmetic and dermatologic history should be included in dry eye evaluations, especially since prescription-strength products are associated with higher risks.

The study identified limitations, such as the lack of clear differentiation between ocular and skin-related adverse events in many studies. The authors called for future research to employ rigorous methodologies that assess both the efficacy and potential harms of topical retinoids concerning ocular health.

Eyecare providers are encouraged to consider these findings when evaluating patients with dry eye or meibomian gland dysfunction, focusing on monitoring potential ocular effects among topical vitamin A users. The need for high-quality studies to clarify the relationship between dosages, formulations, and ocular harms was also emphasized.