Case Report of Corneal Ulceration Associated With Dupilumab

Introduction Dupilumab (DUPIXENT, Regeneron & Sanofi, USA) increases the risk for ocular surface complications in predisposed patients. Although keratoconjunctivitis is the most reported complication, corneal ulceration is rare. This is a case report of corneal ulceration in a patient with dupilumab-associated ocular surface disease. The current understanding of the dupilumab-associated ocular surface disorder and management will be discussed. Case Report A 21-year-old multiracial man presented with exacerbation of atopic keratoconjunctivitis that coincided with the start of dupilumab for the treatment of atopic dermatitis. Despite discontinuation of dupilumab, and aggressive management with topical and oral anti-inflammatory therapy, a corneal ulcer developed following dupilumab treatment. Conclusion This case highlights the challenges in managing atopic keratoconjunctivitis and the potential ocular side effects of dupilumab treatment in atopic dermatitis. Based on current literature, atopic keratoconjunctivitis and other ocular surface disorders are likely underdiagnosed and paradoxically exacerbated by dupilumab in the treatment of atopic dermatitis. Although reports of corneal ulceration in patients using dupilumab are limited, it is unclear if the pathogenesis represents a causative association or an exacerbation from the atopic disease itself. Therefore, patients with atopic dermatitis should be carefully monitored for any eye-related symptoms and, if they occur, have an ophthalmic evaluation. In most cases of atopic keratoconjunctivitis and dupilumab-associated ocular surface disease, continuation of dupilumab is possible.