The Value of Patient-Reported Questionnaires in Detecting Ocular Surface Manifestations in Dupilumab Therapy: A Case-Control Study

Purpose: Dupilumab-associated ocular surface disease (DAOSD) is a reported side effect with several manifestations and uncertain risk factors. This study uses objective assessments and a patient-reported questionnaire to evaluate ocular surface disease (OSD) in Dupilumab-treated patients. Methods: A case-control study at São João Local Health Unit (ULS São João), Porto, Portugal, included 58 Dupilumab-treated adults categorized by the DAOSD Questionnaire. Cases (Group A, n=40) had ≥ 3 symptoms or ≥ 1 severe symptom, while controls (Group B, n=18) had < 3 symptoms without daily impact. Ocular surface parameters were assessed, including eye redness score, non-invasive break-up time (NIBUT), tear meniscus thickness, tear film stability evaluation (TFSE ® ), and tear osmolarity. The Ocular Surface Disease Index (OSDI) classified symptom severity. Results: Group A had significantly higher tear osmolarity (303.43± 7.61 vs 293.31± 5.11 mOsm/L, p< 0.001) and eye redness (2.00 (1.00) vs 1.00 (1.00) points, p= 0.036). TFSE values were higher (252.76± 3.30 vs 138.74± 3.43 points, p=0.094), while NIBUT was lower (1.00 (4.00) vs 6.50 (10.00) s, p=0.078). Conjunctivitis was more frequent in Group A (57.50% vs 33.33%, p= 0.089), followed by posterior blepharitis (40.00% vs 5.56%, p= 0.008). OSDI scores had significantly different mean in Group A (27.32± 20.24 vs 2.11± 3.24 points, p< 0.001), with 37.5% exhibiting severe disease classification. Conclusion: DAOSD is associated with increased symptom burden. The DAOSD questionnaire correlated with OSDI scores and ocular surface changes, supporting its role in early detection and referral for ophthalmological management.