Dupilumab-Associated Blepharoconjunctivitis: Clinical and Morphological Aspects

Area of Science:

• Ophthalmology
• Dermatology
• Immunology

Background:

• Atopic Dermatitis (AD) is a chronic inflammatory skin condition that can affect the ocular surface.
• Dupilumab is a biologic treatment increasingly used for moderate-to-severe AD.
• Ocular surface complications, including conjunctivitis, are reported side effects of Dupilumab.

Purpose of the Study:

• To investigate the clinical and morphologic changes in the ocular surface microstructure of patients with moderate-to-severe AD.
• To compare ocular surface changes before and during Dupilumab treatment.

Main Methods:

• A monocentric observational study included 33 patients with AD, divided into treatment-naive and Dupilumab-treated groups.
• Ocular assessments included slit-lamp examination, tear film tests (BUT, Schirmer, NIKBUT, TMH), corneal staining (Oxford scale), and Redness Score (RS).
• Meibomian Gland Dysfunction (MGD) was evaluated using meibography, and in vivo confocal microscopy examined conjunctival and corneal microstructure.

Main Results:

• Both naive and treated AD patients exhibited tear film instability (reduced TBUT and NIKBUT).
• Meibography revealed a statistically significant loss of meibomian glands (Meiboscore) and increased ocular redness (RS) in Dupilumab-treated patients compared to naive patients.
• Confocal microscopy showed a reduced conjunctival goblet cell population and increased inflammatory cells around meibomian gland openings in the treated group.

Conclusions:

• Dupilumab treatment in moderate-to-severe AD patients is associated with meibomian gland loss, suggesting reduced meibum secretion and evaporative dry eye.
• Ocular surface inflammation in AD may involve the meibomian glands, with Dupilumab potentially playing a role in these changes.
• While conjunctivitis is a known side effect, the observed meibomian gland changes highlight another aspect of ocular surface impact.