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Congenital Restrictive External Ophthalmoplegia and Gustatory Epiphora Associated With Fetal Isotretinoin Toxicity
Arch Ophthalmol. 2002;120:1094-1095.
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Isotretinoin or Accutane (Hoffman–La Roche Inc, Nutley, NJ; 13-cis-retinoic acid) is a vitamin A analogue that was first
licensed in the United States in 1982 for the treatment of cystic acne. Use
of isotretinoin during pregnancy is teratogenic and is associated with a constellation
of fetal malformations collectively termed retinoic acid embryopathy.1
Retinoic acid embryopathy is characterized by craniofacial abnormalities
in the form of hydrocephalus, microcephaly, a narrow, sloping forehead, hypertelorism,
ear deformities, cleft palate, and micrognathia.1
Systemic anomalies include congenital heart defects and thymic malformation.
Reported ophthalmic findings are microphthalmos, optic nerve hypoplasia, and
cortical blindness.2 We describe a child
exposed to isotretinoin during gestation who sought treatment for congenital
restrictive ophthalmoplegia and gustatory epiphora (crocodile tears syndrome).
Report of a Case
An 11-week-old boy with numerous malformations came to our unit with
a history of poor visual tracking from birth. The child's mother had used
isotretinoin (mean daily oral dosage, . . . [Full Text of this Article]
Comment
Corresponding author and reprints: Lawrence Tychsen, MD, Room 2S-89,
St Louis Children's Hospital, One Children's Place, St Louis, MO 63110 (e-mail: tychsen@vision.wustl.edu).
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