Dupilumab-Associated Ocular Surface Disease in Pediatric Atopic Dermatitis: A Single-Center Asian Experience.

Abstract

Background: Atopic dermatitis (AD) is the most common chronic inflammatory skin disorder presenting in childhood. Dupilumab is the first approved biologic agent for the treatment of moderate-to-severe AD in pediatric populations. While generally well-tolerated, dupilumab-associated ocular surface disease (DAOSD) is a known complication. In severe cases, this may necessitate discontinuation of treatment.

Objective: We aim to describe DAOSD in our cohort of Asian pediatric patients with moderate-to-severe AD on dupilumab.

Methods: We performed a single-center retrospective review of children and adolescents on dupilumab for moderate-to-severe AD who developed ophthalmological complications from 2019 to 2024. Most patients had prophylactic lubricant eyedrops. Data collected and analyzed included demographics, ophthalmologic findings, treatment, and outcomes of eye condition.

Results: Of 216 patients treated with dupilumab, 16 (7.4%) developed ophthalmologist-diagnosed DAOSD. All patients had co-existing eyelid or head and neck eczema while 31.3% of these patients had pre-existing eye conditions. Eye redness (87.5%) was the most common presenting symptom, followed by pruritus (43.8%) and eye discharge (25%). The most common eye finding was conjunctivitis (87.5%), followed by limbitis (62.5%) and papillary reaction (62.5%). Two patients required temporary interruption of dupilumab. No patients required discontinuation of dupilumab treatment. The median time to resolution of eye complications was 14 weeks.

Conclusion: In a real-world setting, the incidence and severity of DAOSD in pediatric patients appears to be lower than that of adults. Prophylactic use of lubricant eye drops, close monitoring and early referral to pediatric ophthalmologists can help reduce the incidence of severe eye disease requiring discontinuation of dupilumab.