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Case Reports
. 2025 Feb 1;44(2):250-254.
doi: 10.1097/ICO.0000000000003721.

Dupilumab-Associated Bilateral Conjunctival Papillomas and Corneal Perforation

Nicholas Dewhurst  1 , Conor Larney  2 , Dale Jobson  2   3 , Nour Nofal  1 , Alvin Chong  2 , Elsie Chan  1
Affiliations
Case Reports

Dupilumab-Associated Bilateral Conjunctival Papillomas and Corneal Perforation

Nicholas Dewhurst et al. Cornea. .

Abstract

Purpose: We report a unique case of significant human papillomavirus-associated conjunctival papillomas and severe corneal ulceration leading to corneal perforation in a patient treated with dupilumab for atopic dermatitis.

Methods: This study is a case report and literature review of severe corneal side effects related to dupilumab.

Results: A 27-year-old man with severe atopic dermatitis and no ocular history was administered dupilumab 300 mg via subcutaneous injections every 2 weeks with an excellent response. Following the onset of treatment, the patient developed conjunctivitis, conjunctival papillomas, and dry eyes, which were initially treated with lubricating eye drops. Fourteen months after commencing dupilumab, he had a rapid onset of painful visual loss in the OD accompanied by severe bilateral conjunctival injection and was found to have a central corneal ulcer and diffuse papillomas on the palpebral and bulbar conjunctiva. Despite management with intravenous methylprednisolone and topical dexamethasone, the patient's corneal ulcer progressed to a corneal melt, resulting in perforation 2 months after diagnosis, which necessitated a corneal graft.

Conclusions: We present the third reported case of dupilumab-associated corneal perforation and the first case to our knowledge of dupilumab-associated conjunctival papillomas. As dupilumab usage increases, awareness of these potential complications among prescribers is essential.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

References

    1. Akinlade B, Guttman-Yassky E, Bruin-Weller M, et al. Conjunctivitis in dupilumab clinical trials. Br J Dermatol. 2019;181:459–473.
    1. Popiela MZ, Barbara R, Turnbull AMJ, et al. Dupilumab-associated ocular surface disease: presentation, management and long-term sequelae. Eye (Lond). 2021;35:3277–3284.
    1. Bohner A, Topham C, Strunck J, et al. Dupilumab-associated ocular surface disease: clinical characteristics, treatment, and follow-up. Cornea. 2021;40:584–589.
    1. Wilson MM, Roberts PK, Daniell M. Dupilumab-associated ulcerative keratitis. Int J Ophthalmol. 2022;15:1020–1022.
    1. Li G, Berkenstock M, Soiberman U. Corneal ulceration associated with dupilumab use in a patient with atopic dermatitis. Am J Ophthalmol Case Rep. 2020;19:100848.

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