Peripheral Corneal Perforation Associated With Tralokinumab: A Case Report

To report a case of peripheral corneal perforation associated with tralokinumab use in a patient treated for atopic dermatitis. This is the first documented case of corneal perforation linked to tralokinumab, highlighting the need for ophthalmological monitoring in patients receiving IL-13 inhibitors.

A tertiary hospital in Spain, where the patient was evaluated and treated in the ophthalmology department following an urgent presentation with sudden vision loss.

A 66-year-old woman presented with acute vision loss in one eye over 48 hours. The patient had a history of atopic dermatitis treated with tralokinumab for 18 months but no prior ocular or systemic relevant conditions suggestive. Slit lamp examination revealed a 10 mm corneal perforation, self-sealed by the iris, with an intact ephitelium, edematous borders and underlying stroma thinning in the affected area. Lesion was limited to the inferotemporal sector and within 2 mm of the limbus. Adjacent cornea exhibited no signs of inflammation, adjacent conjunctiva exhibited minimal inflammation, and no scleral involvement was noted. Anterior chamber was moderately shallow, with no signs of inflammation. A corectopic pupil was observed due to iris incarceration within the corneal perforation (figure 1). Left eye showed no abnormalities.

Urgent surgical intervention was performed, consisting of 11 sutures, as there was no loss of tissue or necrotic borders, and amniotic membrane transplantation. In addition, patient received medical treatment with oral prednisone, doxycycline, ascorbic acid, and topical tobramycin, dexamethasone and insulin eye drops.

Extensive systemic and autoimmune workups were unremarkable except for elevated C-reactive protein. Given the lack of alternative etiologies, tralokinumab was considered the likely cause, leading to its discontinuation in coordination with dermatology. The patient showed significant improvement at two months postoperatively (figure 2).

This case suggests that tralokinumab, like other IL-13 inhibitors, may carry a risk of severe ocular complications, including corneal perforation. While its incidence is rare, clinicians should be aware of this potential adverse effect. Early recognition and appropriate management, including discontinuation of the drug when necessary, are crucial for preventing vision-threatening complications. Routine ophthalmological monitoring should be considered for patients receiving tralokinumab.