Dupilumab-Associated Blepharitis In A Pediatric Patient With Atopic Dermatitis

Dupilumab is a monoclonal antibody that has been approved for the treatment of atopic dermatitis and asthma. However, there have been reported cases of blepharitis, an inflammation of the eyelids, in patients treated with dupilumab. 

This is of particular concern in pediatric patients, as blepharitis can cause significant discomfort and even vision problems if left untreated. The aim of this work is to report a case of dupilumab-associated blepharitis in a pediatric patient with atopic dermatitis.

Centro Hospitalar Universitário São João, Porto, Portugal

Clinical case description, including eyelids and anterior segment pictures.

A 17-year-old male presented with symptoms of bilateral blurred vision, ocular irritation and eyelids redness. The patient's medical history included a 15-year history of severe atopic dermatitis, for which previous treatment with topical corticosteroids had been unsuccessful. The patient subsequently enrolled in a trial of biweekly injections of dupilumab. Upon examination with a slit lamp, edematous eyelids with crusting of the eyelashes, bilateral meibomian gland dysfunction and a reduced TBUT were observed. Despite eyelid hygiene regimen, prednisolone/chloramphenicol ophthalmic ointment and artificial tears, the patient did not experience any improvement in symptoms. As a result, it was necessary to discontinue dupilumab treatment.

In conclusion, while topical steroids and antibiotics in combination with eyelid hygiene are commonly used to treat atopic dermatitis patients experiencing ocular side effects from dupilumab, it has been found that these methods may not always be sufficient. Further research is required to fully comprehend the prevalence and risk factors for blepharitis associated with dupilumab, as well as to establish effective treatment and management techniques for this condition.