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. 2021 Dec;35(12):3277-3284.
doi: 10.1038/s41433-020-01379-9. Epub 2021 Jan 28.

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

Magdalena Z Popiela  1   2 , Ramez Barbara  1 , Andrew M J Turnbull  1   3 , Emma Corden  1 , Beatriz Suarez Martinez-Falero  1 , Daniel O'Driscoll  1 , Michael R Ardern-Jones  1   4 , Parwez N Hossain  5   6
Affiliations

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

Magdalena Z Popiela et al. Eye (Lond). 2021 Dec.

Abstract

Objectives: To determine the presenting features of ocular surface disease in patients with atopic dermatitis (AD) treated with dupilumab at a tertiary, university hospital. To establish the need for treatment of dupilumab-associated ocular surface disease and report any long-term effects on the ocular surface.

Methods: A retrospective analysis of consecutive patients treated with dupilumab for AD between January 2017 and August 2019 was undertaken. Data were collected on demographics, incidence and type of ocular disease features, natural history and treatment.

Results: A total of 50% (14/28) patients developed ocular symptoms with a mean time of onset of 6.75 (±6.1) weeks from starting dupilumab. Of these, 69% (9/13) were diagnosed with conjunctivitis associated with cicatrisation in two patients and periorbital skin changes in four. Of these nine, four had prior history of atopic keratoconjunctivitis. All were treated with topical steroids; two required additional ciclosporin drops. In all, 67% (6/9) patients went on to have on-going ocular inflammation requiring maintenance drops at a mean of 16 (±6.9) months of follow-up. All patients had improvement in their AD severity; only one patient discontinued dupilumab due to ocular side effects.

Conclusion: The rate of dupilumab-associated ocular surface disease was 32%. Periorbital skin changes and conjunctival cicatrisation were noted in association with conjunctivitis. Ocular surface disease improved on topical steroids and ciclosporin but 67% of patients needed on-going treatment. Close liaison with an ophthalmologist should be considered in those patients who develop conjunctivitis or have a past history of severe ocular surface disease.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Acute presentation of dupilumab-associated conjunctivitis and its resolution with drops.
A–C Patient with acute dupilumab-associated conjunctivitis. D Same patient 6 weeks post initiation of steroid therapy.
Fig. 2
Fig. 2. Conjunctival cicatrisation in patient on dupilumab.
Patient on dupilumab with progressive cicatrisation and leukoplakic lesion in lower fornix.
See this image and copyright information in PMC

Comment in

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