Ocular surface evaluation in atopic dermatitis patients on dupilumab: A prospective observational study

To describe the ocular surface findings in atopic dermatitis patients treated with dupilumab.

This is an observational study including atopic dermatitis patients treated with dupilumab from January 2018 to July 2019. At baseline, patients underwent dermatological and ophthalmological assessments and at least one other joint visit during the 6-month follow-up. Appointments were scheduled at baseline, 1, 3, and 6months for ophthalmologists. Ocular assessment included past ocular history and symptoms, Ocular Surface Disease Index (OSDI) score, slit lamp examination, tear film Break Up Time and Schirmer's test. Atopic dermatitis severity scores were assessed at baseline and 3 and 6months by dermatologists.

Forty-six patients were included. Among them, 31 (67%) had preexisting ocular surface disease at baseline. Mean follow-up was 7.1±1.6months. At the 6-month endpoint, 8 patients (17%) developed newly diagnosed ocular surface disease; 13 patients (28%) experienced exacerbation of ocular surface disease; 8 patients (17%) had stable ocular surface disease, 10 patients (22%) experienced an improvement in their ocular surface disease on dupilumab, and 7 patients (15%) had no ocular surface disease from baseline to the endpoint. The presence of eyelid eczema at baseline was associated with the occurrence of dupilumab induced ocular surface disease. Only 3 patients (7%) had to discontinue treatment due to ocular adverse events.

Atopic dermatitis patients treated with dupilumab may develop polymorphic, potentially severe ocular surface disease. These results highlight the need for careful examination of the eyelids and globe of atopic dermatitis patients and early examination by ophthalmologists if conjunctivitis does not resolve with non-steroid eye drops.