Delayed-Onset Unilateral Hyperemia and Foreign-Body Sensation Following Dupliumab Therapy for Atopic Dermatitis

Purpose: We present a case of dupilumab-associated ocular surface disease presenting as atypical superior filamentary keratitis and describe our treatment approach.Case summary: A 20-year-old male receiving dupilumab for atopic dermatitis was referred for bilateral ocular discomfort 2 months after treatment initiation. Examination revealed follicular hyperplasia of the left superior palpebral conjunctiva, limbal elevation and hyperemia, corneal infiltration, and superficial neovascularization, consistent with severe atopic keratoconjunctivitis. Considering the inflammation was refractory to prior long-term therapy, the patient was treated with topical corticosteroids, antibiotics, and a sub-Tenon triamcinolone injection; however, the clinical course fluctuated with repeated improvement and deterioration. Despite subsequent tacrolimus therapy, characteristic filaments developed in the superior cornea of both eyes with significant exacerbation following dupilumab administration. Subjective symptoms improved after the patient voluntarily discontinued dupilumab. Subsequently, the condition stabilized after extending the dupilumab dosing interval and the patient remains under observation with ongoing medication adjustments.Conclusions: Dupilumab treatment can induce corneal filament formation, particularly in the superior area. Patients with a history of ocular disease or those receiving ophthalmic medications should be monitored closely during therapy.