Dupilumab-associated ocular surface disease: presentation, management and long-term sequelae.

Area of Science:

• Ophthalmology
• Dermatology
• Immunology

Background:

• Atopic dermatitis (AD) is a chronic inflammatory skin condition.
• Dupilumab is a biologic therapy targeting the IL-4/IL-13 pathway for moderate-to-severe AD.
• Ocular manifestations can occur in patients with AD.

Purpose of the Study:

• To identify the ocular surface disease features in patients with AD treated with dupilumab.
• To assess the need for and long-term effects of treating dupilumab-associated ocular surface disease.

Main Methods:

• Retrospective analysis of 28 patients with AD treated with dupilumab.
• Data collection included demographics, ocular disease incidence and type, and treatment outcomes.
• Follow-up data on ocular inflammation and treatment duration were recorded.

Main Results:

• 32% of patients developed ocular symptoms, with a mean onset of 6.75 weeks after starting dupilumab.
• Conjunctivitis was the most common diagnosis (69% of affected patients), with some cases involving cicatrisation and periorbital skin changes.
• 67% of patients with ocular disease required ongoing treatment for ocular inflammation for a mean of 16 months.

Conclusions:

• Dupilumab-associated ocular surface disease occurs in a significant proportion of AD patients.
• While treatable with topical steroids and ciclosporin, many patients require long-term management.
• Ophthalmologist consultation is advised for patients developing conjunctivitis or with a history of severe ocular surface disease.