Abstract
Purpose :
This study aimed to investigate the most common presentation of patients developing dupilumab-associated ocular surface disease (DAOSD), propose a grading system for DAOSD, and elucidate the natural course and treatment strategies of DAOSD.
Methods :
Retrospective chart review of patients with concomitant dupilumab-treated atopic dermatitis (AD) and DAOSD with ophthalmologic evaluation at Oregon Health & Science University from 2014-2019.
Results :
We identified 29 patients (mean age 46 y, M/F: 12/17) with 57 exams (table 1). Nine patients had a history of allergic conjunctivitis, and 2 had a history of atopic keratoconjunctivitis. Twenty-six (90%) and 19 (66%) had a history of facial and eyelid AD, respectively. The most common ocular symptoms included irritation (n=26, 89%), redness (n=24, 83%), pruritus (n=18, 62%), tearing (n=18, 62%) and light sensitivity (n=6, 21%). The most frequent signs included conjunctival injection (n=18, 62%), superficial punctate keratitis (n=16, 55%) and papillary reaction (n=8, 28%). Other signs included follicular reaction (n=4, 14%), and mucous discharge (n=3, 10%). Twenty-seven were diagnosed with conjunctivitis, 2 with blepharitis, and 2 with keratitis. Common therapies included topical steroids (n=20, 70%), tacrolimus (n=5, 17%), and artificial tears (n=5, 17%), and 81% noted moderate improvement or full resolution with steroid therapy.
Conclusions :
This study elucidates DAOSD-associated ocular signs and symptoms and suggests good efficacy of topical steroids in improving symptoms. Identification and treatment of DAOSD appears to improve patient symptoms, allowing for continued use of dupilumab in patients with severe AD. Given the known complications associated with topical ocular steroids, risk-benefit management is necessary to avoid unnecessary complications and patient expense. We propose a 4-point grading system (table 2) using symptom history as a method to determine clinical severity in order to direct need for therapeutic intervention and frequency of follow-up visits. We propose managing mild disease (scores of ≤2) with monitoring or low-dose topical steroid therapy, while severe disease (≥3) warrants more frequent evaluation by ophthalmology and consideration of higher-potency therapies. Pre-existing eyelid or facial AD may be associated with an increased susceptibility for DAOSD—further study is warranted to investigate this hypothesis.
This is a 2020 ARVO Annual Meeting abstract.