Management Of Severe Ocular Complications In A Patient With Atopic Dermatitis Treated With Dupilumab.

To describe the clinical course and therapeutic management of severe ocular complications in a 78-year-old patient with atopic dermatitis treated with dupilumab.

Complejo Hospitalario Universitario de Canarías

We present the case of a patient who, 2 months after starting dupilumab, developed ocular symptoms (periocular scaling, whitish discharge, photophobia and bilateral pruritus). Prospective follow-up was performed using EDTRS (Early Treatment Diabetic Retinopathy Study) visual acuity assessments and slit-lamp examination, documenting corneal findings with special attention to active ulcers and peripheral thinning. Interventions included, sequentially, topical therapies (Exocin, Tacrolimus, Insulin, Softacort, Recugel), the addition of oral doxycycline, TBI, use of ICOL Ointment and amniotic membrane placement. If the lesions persisted and recurred, dupilumab was discontinued, with follow-up for up to 6 months.

At initial assessment, visual acuity was 20/20 in both eyes, and slit-lamp examination showed in the right eye a 1 × 2 mm active ulcer with inferior corneal thinning and on the left eye a 1 × 1 mm ulcer with inferotemporal thinning. During follow-up, despite multiple interventions, persistence and even worsening of the corneal thinning was evident, with new ulcers appearing, particularly in the left eye. Placement of the amniotic membrane at 4 months led to resolution of the ulcers and corneal thinning, although initially there was a transient decrease in visual acuity (20/83), which subsequently normalised (20/20). Finally, after discontinuation of dupilumab, ocular surface stability was observed with resolution of the active lesions.

The present case shows that dupilumab treatment in patients with atopic dermatitis may be associated with severe and recurrent ocular complications, including corneal ulcers and peripheral thinning, which may require complex therapeutic interventions. Close monitoring of ocular health and consideration of treatment discontinuation are critical to avoid permanent damage to the ocular surface.