Isotretinoin is a highly effective treatment for moderate-to-severe acne vulgaris but is associated with a broad spectrum of ophthalmic adverse effects. While dry eye disease secondary to meibomian gland dysfunction is the most common ocular complication, less familiar manifestations include nyctalopia, corneal abnormalities, retinal changes, idiopathic intracranial hypertension, and optic neuritis. Current evidence suggests that isotretinoin induces structural and functional changes in the meibomian glands, resulting in tear film instability and evaporative dry eye disease. Although many of these changes appear reversible following treatment cessation, some patients may experience persistent symptoms. This review was conducted as a structured narrative review of the ophthalmic adverse effects associated with systemic isotretinoin use. A literature search was performed using PubMed and Embase for articles published from inception to 1 June 2026. Nyctalopia is a well-established adverse effect attributable to rod photoreceptor dysfunction and may have important implications for occupations requiring optimal night vision. Corneal remodelling and ocular surface dysfunction are particularly relevant in contact lens wearers and patients considering refractive and corneal surgery, for instance corneal transplants. Rare but potentially sight-threatening neuro-ophthalmic complications have also been reported. Clinicians prescribing isotretinoin should routinely enquire about visual symptoms and maintain a low threshold for ophthalmic referral. Early recognition and collaborative management between dermatologists, general practitioners, and eye care practitioners are essential to minimise visual morbidity, promote ocular comfort and optimise patient outcomes. This review aimed to provide an updated, clinically focused synthesis of the ophthalmic adverse effects of isotretinoin, emphasising pathophysiological mechanisms, clinical presentation, evidence supporting reversibility, and practical recommendations for ophthalmologists, dermatologists, and primary care clinicians.