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Related Experiment Video

Updated: Sep 27, 2025

Induction of Ocular Surface Inflammation and Collection of Involved Tissues

Induction of Ocular Surface Inflammation and Collection of Involved Tissues

Published on: August 4, 2022

Dupilumab-induced ocular surface disease: a primer.

Merin Anna Reji¹, Aaisha Haque², Supriya Goyal³

¹Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.

BMJ Case Reports

|April 13, 2022

Summary

Dupilumab effectively treats atopic diseases but can cause ocular surface issues like dry eyes due to mucin deficiency. Awareness is crucial for managing this unique complication in patients on this biologic therapy.

Keywords:

Dermatology Eye Immunology Ophthalmology Unwanted effects / adverse reactions

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Area of Science:

Immunology
Dermatology
Ophthalmology

Background:

Atopic diseases are increasingly managed with targeted biological therapies.
Dupilumab, a monoclonal antibody, targets the interleukin-4 (IL-4) receptor, inhibiting IL-4 and IL-13 signaling.
This precision therapy has revolutionized treatment for conditions like atopic asthma, eczema, and rhinitis.

Observation:

A patient with severe atopic asthma, food allergy, and eczema experienced significant improvement with dupilumab.
However, she developed severe blepharoconjunctivitis, dry eyes, and periorbital dermatitis during treatment.
These symptoms were consistent with dupilumab-induced ocular surface disease and mucin deficiency.

Findings:

Dupilumab therapy led to remission of atopic symptoms but induced ocular complications.
The ocular issues included severe dry eyes and inflammation.
The proposed mechanism involves dupilumab-induced cytokine imbalance affecting ocular goblet cells and mucin production.

Implications:

Primary care providers and subspecialists must be aware of potential ocular side effects of dupilumab.
Prompt recognition and management of dupilumab-associated ocular surface disease are essential.
Aggressive ocular treatment allowed the patient to continue beneficial dupilumab therapy for her atopic conditions.