A Clinician's Guide to Dupilumab-related Ocular Surface Disease

Atopic dermatitis (AD) commonly presents in both children and adults with pruritic, eczematous lesions that can have a substantial impact on quality of life. Current biologics approved for AD include dupilumab, an IL-4 receptor alpha inhibitor, tralokinumab, an IL-13 inhibitor, lebrikizumab, an IL-13 inhibitor, and nemolizumab, an IL-31 receptor alpha inhibitor. Dupilumab, tralokinumab, and lebrikizumab are highly effective in addressing the inflammatory response and reducing pruritus in AD patients via the IL-13 pathway, but are also associated with conjunctivitis and ocular surface disorders (OSD) in some patients, especially compared to other biologics that do not inhibit the activity of IL-4 and/or IL-13. For practitioners, it is important to be aware that OSD is a relatively common side effect but rarely causes problems severe enough to lead to cessation of treatment. This brief report provides guidance on screening and managment of OSD in patients with AD receiving anti-IL-4 and/or IL-13 treatment.