Cornea · 2026
Severe Dupilumab-Associated Ocular Surface Disease: Multicenter Experience and Management Considerations.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Kufta Allison, Kazmi Syeda Zainab, Ghalibafan Seyyedehfatemeh, Kwon Jeonghyun, Sharma Rishi, Sun Josh, Nijm Lisa M, Tu Elmer Y, Cortina Maria S, Farooq Asim V, Soleimani Mohammad, Amber Kyle T, Ashraf Mohammadali, Saeed Hajirah N, Djalilian Ali R
Аннотация
PURPOSE: To evaluate severe dupilumab-associated ocular surface disease (DAOSD) and identify clinical features, risk factors, and outcomes associated with delayed ophthalmologic referral.
METHODS: A multicenter retrospective case series of 13 patients (26 eyes) with severe DAOSD presenting to tertiary centers between January 2014 and April 2026 was conducted. Clinical findings were analyzed alongside a focused review of current evidence on pathophysiology, diagnosis, and management.
RESULTS: Initial ocular symptoms were frequently mild and nonspecific, most commonly redness and pruritus (13/13, 100%), followed by blurred vision with tearing (3/13, 23.1%), eye pain (2/13, 15.4%), and mucoid discharge (2/13, 15.4%), contributing to delayed referral. Symptom onset ranged from 0 to 37 months after dupilumab initiation (mean 11.7 months). At presentation, advanced disease manifestations included limbitis (3/13, 23.1%), conjunctivalization with corneal neovascularization (3/13, 23.1%), limbal stem cell deficiency (2/13, 15.4%), and cicatricial conjunctivitis (1/13, 7.7%). Preexisting atopic ocular disease was present in 6/13 patients (46.2%). Management included lubrication, topical corticosteroids, calcineurin inhibitors, and scleral lenses. Dupilumab was discontinued in 7/13 patients (53.8%). Clinical stabilization was achieved in 12/13 patients (92.3%) over a mean follow-up of 21.4 ± 20.3 months.
CONCLUSIONS: Severe DAOSD may be underrecognized, as mild early symptoms can delay referral and allow progression to advanced, vision-threatening complications. Preexisting ocular surface disease identifies a high-risk subgroup. Early ophthalmologic evaluation and timely referral are essential to prevent irreversible ocular surface damage and vision loss.
METHODS: A multicenter retrospective case series of 13 patients (26 eyes) with severe DAOSD presenting to tertiary centers between January 2014 and April 2026 was conducted. Clinical findings were analyzed alongside a focused review of current evidence on pathophysiology, diagnosis, and management.
RESULTS: Initial ocular symptoms were frequently mild and nonspecific, most commonly redness and pruritus (13/13, 100%), followed by blurred vision with tearing (3/13, 23.1%), eye pain (2/13, 15.4%), and mucoid discharge (2/13, 15.4%), contributing to delayed referral. Symptom onset ranged from 0 to 37 months after dupilumab initiation (mean 11.7 months). At presentation, advanced disease manifestations included limbitis (3/13, 23.1%), conjunctivalization with corneal neovascularization (3/13, 23.1%), limbal stem cell deficiency (2/13, 15.4%), and cicatricial conjunctivitis (1/13, 7.7%). Preexisting atopic ocular disease was present in 6/13 patients (46.2%). Management included lubrication, topical corticosteroids, calcineurin inhibitors, and scleral lenses. Dupilumab was discontinued in 7/13 patients (53.8%). Clinical stabilization was achieved in 12/13 patients (92.3%) over a mean follow-up of 21.4 ± 20.3 months.
CONCLUSIONS: Severe DAOSD may be underrecognized, as mild early symptoms can delay referral and allow progression to advanced, vision-threatening complications. Preexisting ocular surface disease identifies a high-risk subgroup. Early ophthalmologic evaluation and timely referral are essential to prevent irreversible ocular surface damage and vision loss.