Topical treatment of dupilumab-associated refractory conjunctivitis and keratitis

PURPOSE: To report 3 cases of severe dupilumab-related conjunctivitis and keratitis topical treatment. OBSERVATION: Description, management, and outcomes of dupilumab-related refractory conjunctivitis associated with punctate keratitis. Three patients with atopic dermatitis (AD) experiencing severe ophthalmic complications following dupilumab treatment were referred to us when conventional management methods failed. We treated them topical and external pimecrolimus 10 mg/g cream to the eyelids. The patients showed substantial clinical remission within 10 days. CONCLUSIONS AND IMPORTANCE: Those cases are remarkable as a drug applied externally to the eyelid skin successfully treated underlying conjunctivitis and punctate keratitis. The complete clinical remission suggests that pimecrolimus applied topically to the eyelid skin is a safe and effective delivery route. The resolution of the keratitis and conjunctivitis presumably represents either a contiguous effect of the improvement of the cutaneous inflammation, or the effect of transcutaneous pimecrolimus penetration through the eyelid. Further studies are needed to support the use of this drug for dupilumab-associated conjunctivitis.