Official ESCRS | European Society of Cataract & Refractive Surgeons


Dupilumab-induced ocular surface disease (DIOSD): a case series

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Session Details

Session Title: Cornea: Medical

Session Date/Time: Monday 16/09/2019 | 08:30-10:30

Paper Time: 08:48

Venue: Free Paper Forum: Podium 2

First Author: : Y.Nahum ISRAEL

Co Author(s): :    E. Livny   I. Bahar   Y. Leshem                       

Abstract Details


Dupilumab (Dupixent, Regeneron Pharmaceuticals) is a monoclonal antibody against the IL4 receptor. Through its action, it blocks both IL4 and IL13 signaling pathways. This drug is the only FDA-approved treatment for moderate to severe atopic dermatitis, and is considered a revolutionary drug in the management of this common debilitating disease. Ocular surface inflammation is the most common side effect of Dupilumab, seen in up to 50% of atopic dermatitis patients in clinical trials. The purpose of this study was to describe the ocular side effects of Dupilumab and their treatment in a university hospital.


Retrospective case series, Institutional study done at Rabin Medical Center, Petach Tikva, Israel


Patients with atopic dermatitis which received Dupilumab at Rabin Medical Center (Petach Tikva, Israel) from April 2018 were included. Self reported ocular surface disease prior to dupilumab therapy, as well as symptoms, slit lamp examination and Schirmer test following Dupilumab treatment were noted as well as therapy used for presumed DIOSD.


Twenty-nine patients aged 18-81 rwere included in the study. Out of 14 patients with no prior atopic keratoconjunctivitis(AKC), three had new signs and symptoms of ocular surface disease including dry eye, conjunctivitis and blepharitis, following dupilumab. Out of 15 patients with prior AKC, 10 had reported excerbation of ocular symptoms, with conjunctivitis and blepharitis starting from up to a 2 weeks following duplimuab. Patients with mild presumed DIOSD were treated with lubrication, olopatadine or azelastine drops. Patients with more pronounced disease were treated with Tacrolimus ointment with alleviation of signs and symptoms from up to 2 days following this therapy.


The prevalence of DIOSD in our case series was 13/29 (45%). DIOSD ranged from mild self-limiting conjunctivitis to marked bleharoconjunctivitis. Prior AKC is associated with the occurrence of DIOSD (OR=7.3, P=0.02, fisher's exact test). DIOSD responded well to non-steroidal medical therapy allowing the patients to continue using dupilumab.

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