The Value of Patient-Reported Questionnaires in Detecting Ocular Surface Manifestations in Dupilumab Therapy: A Case-Control Study.

PURPOSE: Dupilumab-associated ocular surface disease (DAOSD) is a reported side effect with several manifestations and uncertain risk factors. This study uses objective assessments and a patient-reported questionnaire to evaluate ocular surface disease (OSD) in Dupilumab-treated patients.

METHODS

A case-control study at São João Local Health Unit (ULS São João), Porto, Portugal, included 58 Dupilumab-treated adults categorized by the DAOSD Questionnaire. Cases (Group A, n=40) had ≥3 symptoms or ≥1 severe symptom, while controls (Group B, n=18) had <3 symptoms without daily impact. Ocular surface parameters were assessed, including eye redness score, non-invasive break-up time (NIBUT), tear meniscus thickness, tear film stability evaluation (TFSE®), and tear osmolarity. The Ocular Surface Disease Index (OSDI) classified symptom severity.

RESULTS

Group A had significantly higher tear osmolarity (303.43±7.61 vs 293.31±5.11 mOsm/L, p<0.001) and eye redness (2.00 (1.00) vs 1.00 (1.00) points, p=0.036). TFSE values were higher (252.76±3.30 vs 138.74±3.43 points, p=0.094), while NIBUT was lower (1.00 (4.00) vs 6.50 (10.00) s, p=0.078). Conjunctivitis was more frequent in Group A (57.50% vs 33.33%, p=0.089), followed by posterior blepharitis (40.00% vs 5.56%, p=0.008). OSDI scores had significantly different mean in Group A (27.32±20.24 vs 2.11±3.24 points, p<0.001), with 37.5% exhibiting severe disease classification.

CONCLUSION

DAOSD is associated with increased symptom burden. The DAOSD questionnaire correlated with OSDI scores and ocular surface changes, supporting its role in early detection and referral for ophthalmological management.