Isotretinoin is associated with meibomian gland dysfunction and lid margin disease.

• A. Prednisone
• B. Isotretinoin
• C. Methotrexate
• D. Cyclosporine

Answer: (B)

Isotretinoin reduces the activity of sebaceous glands throughout the body, including the meibomian glands that line the eyelids. When these glands make less meibum, the lipid layer of the tear film becomes thinner, tearing becomes more evaporative, and the tear film destabilizes. This sequence leads to meibomian gland dysfunction and lid margin inflammation, producing symptoms and signs of lid margin disease such as crusting, irritation, and telangiectasia along the lid margins. In short, isotretinoin’s effect on meibomian glands directly links it to these ocular surface changes, whereas the other medications listed do not characteristically cause this pattern of MGD and lid margin disease.