Dupilumab Elevates Dry Eye Disease Prevalence in Patients With Atopic Dermatitis

Dupilumab treatment may increase dry eye prevalence and result in adverse ocular surface side effects.

Subcutaneous injections of dupilumab may increase the prevalence of dry eye disease (DED) among individuals with atopic dermatitis, according to research published in Cornea

Researchers included patients with atopic dermatitis who were treated with dupilumab (n=36; mean age, 35.84 years; 61.1% men) and control group participants (n=36; mean age, 35.8 years; 58.3% men) in the prospective, case-control investigation. Study participants underwent Ocular Surface Disease Index (OSDI), tear film breakup time, osmolarity, Oxford staining score, and Schirmer assessments at baseline and during 1- and 6-month follow-up visits after initiating dupilumab treatment. The primary outcome was the change in DED prevalence in patients receiving treatment vs the control group.  

Overall, DED prevalence increased from 16.7% at baseline to 33.3% at 6 months among participants treated with dupilumab (P=.001) and remained unchanged in the control group (P=.110). The researchers observed no associations between the Eczema Area and Severity Index and DED prevalence.

Additional changes from baseline to 6 months included a trend toward increased OSDI (8.5 vs 11.0; P=.068), and significantly increased Oxford score ( 0.1 vs 0.3; P=.050), tear film breakup time (7.8 vs 7.1 seconds; P <.001) and Schirmer test results (15.4 vs 13.2 mm; P =.036) in patients treated with dupilumab compared with control group participants. These variables did not change significantly in the control group between the baseline and 6-month visits, and osmolarity remained unchanged in both groups (P>.05 for both).

Ocular side effects at 6 months in individuals undergoing dupilumab treatment included conjunctivitis (42%), blepharitis (36%), and keratitis (2.8%). No severe side effects or discontinuations of the drug were reported. 

“The increase of DED prevalence in the group of patients treated with dupilumab and concomitant stability of DED prevalence in the healthy group suggest that dupilumab may interact with the ocular surface pathogenetic mechanisms leading to the development of dry eye,” the study authors explain.

Study limitations include the use of a control group that did not have atopic dermatitis.


Marolo P, Ribero S, Caselgrandi P, et al. Ocular surface disease in patients with atopic dermatitis treated with dupilumab: a prospective case–control studyCornea. Published online July 4, 2023. doi:10.1097/ICO.0000000000003341