Characterising the chronicity of dupilumab-associated ocular surface disease: an analysis of a retrospective case series

Abstract

Background/aimsTo describe the clinical presentation and treatment response of dupilumab-associated ocular surface disease (DAOSD).MethodsThis is a retrospective case series of atopic dermatitis patients with DAOSD treated with dupilumab. All consecutive patients with atopic dermatitis referred by dermatologists for suspicion of DAOSD between May 2018 and June 2020 were systemically assessed by a single ophthalmologist. Presenting signs of DAOSD, duration of treatment and associated response are described.ResultsTwenty-eight patients had DAOSD during the study period. Average age was 45.6±14.8 years and 13 (46%) were female. Average follow-up was 15±10 months. Most presentations consisted in diffuse, inflammatory conjunctivitis (n=19, 68%). Other signs included peripheral corneal infiltrates (n=7, 25%), limbal nodules (n=7, 25%) and dry eye syndrome (n=6, 21%). To control ocular symptoms, tapering of corticosteroid eyedrops was slow: taper duration of strong and mild corticosteroid eyedrops averaged 10±8 weeks and 49±34 weeks, respectively. Four patients (14%) required an increase of corticosteroid eyedrops during taper due to clinical deterioration. Corticosteroid eyedrops were still required at final follow-up among 10 patients (36%). Dupilumab was temporarily stopped in 3 patients (11%), one of which did not wish to resume dupilumab for unrelated reasons. Symptomatic improvement and/or complete resolution was achieved in 25/26 patients at follow-up (96%) with empirical treatment.ConclusionsDAOSD may follow the course of a chronic illness. Long-term corticosteroid eyedrops were required in many patients and when taper was possible, this was done after a prolonged treatment duration. Most patients’ ocular symptoms could be controlled, allowing dupilumab continuation.

Dupilumab‐associated ocular surface disease in atopic dermatitis patients: Clinical characteristics, ophthalmic treatment response and conjunctival goblet cell analysis

“…In our study, the number of GCs slightly increased over time, while the percentage of CK19‐CD45‐MUC5AC+ cells decreased significantly, suggesting functional changes of GCs during treatment with dupilumab, possibly leading to DAOSD. In addition, the decrease in percentage of CK19‐CD45‐MUC5AC+ cells might also lead to the dry eye sensation, which has been reported as sign of DAOSD 25 . The tear film, which protects and lubricate the ocular surface, consists of three layers: a lipid layer produced by the Meibomian glands, an aqueous layer produced by the lacrimal gland, and a mucus layer produced by the GCs 26 .…”

“…In addition, the decrease in percentage of CK19-CD45-MUC5AC+ cells might also lead to the dry eye sensation, which has been reported as sign of DAOSD. 25 The tear film, which protects and lubricate the ocular surface, consists of three layers: a lipid layer produced by the Meibomian glands, an aqueous layer produced by the lacrimal gland, and a mucus layer produced by the GCs. 26 Since the Schirmer's test remained stable, or even increased during dupilumab treatment, the dry eye sensation cannot be the consequence of insufficient tear production, but seems to be attributed to less mucus production by GCs and/or dysfunction of the Meibomian glands.…”