Dupilumab-Related Ocular Surface Disease in Atopic Dermatitis: Risk Stratification, Monitoring, and Persistence-Preserving Management.

Background/Objectives: Dupilumab-related ocular surface disease (DROSD) is a significant safety challenge in atopic dermatitis (AD) management, potentially leading to treatment interruption despite cutaneous efficacy. This narrative review evaluates risk stratification and management strategies to standardize monitoring and preserve long-term drug persistence. Methods: A search of PubMed/MEDLINE was conducted from inception to 31 December 2025. Evidence was synthesized from clinical trials, pooled safety analyses, and real-world registries, focusing on risk factors, monitoring tools, and interdisciplinary management algorithms for DROSD in AD populations. Results: Clinical trials identify conjunctivitis as a reproducible, context-dependent signal enriched in AD populations. Real-world data highlight that ocular symptoms disproportionately drive treatment dissatisfaction and discontinuation. Clinical vigilance must extend throughout the treatment course; while many cases appear early, a significant proportion develops between 8-16 weeks, with late-onset manifestations reported up to 12 months after initiation. Effective management relies on baseline risk documentation-including prior ocular history and AD phenotype-and the implementation of stepwise, severity-based "treat-through" protocols. Conclusions: Managing DROSD is a critical strategy for maintaining treatment persistence. Integration of routine baseline risk capture, continuous symptom surveillance, and structured multidisciplinary escalation pathways is essential to maximize ocular safety and long-term therapeutic outcomes in AD.