Clinical Outcomes of Dupilumab-Associated Ocular Surface Disease in the Paediatric Population

Background The aim of this study is to characterise dupilumab-associated ocular surface disease (DAOSD) and its management in the paediatric population. Methods Retrospective data were obtained from the electronic medical records of a tertiary Australian paediatric public hospital's Ophthalmology department for patients reviewed between 1 January 2021 and 1 December 2024. Demographic information was recorded, including gender, age when dupilumab was started, ethnicity, dupilumab indication, past medical history, and baseline serology testing. Clinical characteristics collected included presenting visual acuity (VA), ophthalmological findings, ocular treatment, time to onset and resolution of DAOSD, and final ophthalmological outcome. Cessation of dupilumab due to DAOSD was also noted. Results A total of 13 patients were identified with DAOSD. The mean time from starting dupilumab to onset of DAOSD was 24 weeks (7.3-97.9 weeks). The mean time from onset of ocular symptoms to ophthalmology review was 3.6 weeks (range 0.1-8). The mean baseline VA was logMAR 0.01 (range 0-0.3). Ophthalmological examination findings included conjunctival injection (n=9, 69%), papillary reaction (n=5, 39%), superficial punctate keratitis (n=5, 39%), limbitis (n=3, 23%), and periocular involvement (n=2, 14%). Management included lubricant eye drops (n=13, 100%), topical steroid drops (n=9, 80%), topical antihistamines/mast cell stabiliser eye drops (n=5, 39%), and systemic azithromycin (n=1, 8%). The mean final VA was logMAR 0.06 (range 0-0.3). Three (23%) patients discontinued dupilumab due to ocular or systemic side effects. Conclusions Early ophthalmological assessment and intervention can lead to positive final visual outcomes in paediatric patients experiencing DAOSD. Future studies should investigate the long-term effects of DAOSD treatment in the paediatric population.