New insights on ocular surface disease in patients with atopic dermatitis treated with dupilumab.

Dupilumab was approved by the Food and Drug Administration and European Medicine Agency in 2017 for use in adults with moderate-to-severe atopic dermatitis (AD) [1]. One of the most commonly reported adverse events of dupilumab is ocular surface disease, initially termed "conjunctivitis" in clinical trials [2]. A more appropriate definition is dupilumab-induced ocular surface disease (DIOSD), first proposed by Zirwas [3]. Typical symptoms of DIOSD include tearing, foreign body sensation, burning sensation, itching and photophobia [1-3]. Our study sought to describe ocular surface alterations at baseline and after 4 months of dupilumab treatment in patients with severe AD. We included in the study 25 patients who underwent ophthalmological evaluation at baseline (t0) and after 4 months of dupilumab treatment (t1). In the context of ocular assessment, all patients completed the Ocular Surface Disease Index (OSDI) questionnaire, a standardized evaluation scale of dry eye-related symptoms [4]. Seven subjects of our cohort (28%) had a past history of conjunctivitis, in line with the reported prevalence of keratoconjunctivitis in AD patients [5]. Patients treated with dupilumab were compared at t0 and t1 to a non-atopic control group composed by 25 subjects.