From the Guidelines
There is no evidence that Dupixent (dupilumab) causes optic nerve damage. Dupixent is a biologic medication that blocks interleukin-4 and interleukin-13 signaling and is approved for treating atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyps, and eosinophilic esophagitis. The most common ocular side effects associated with Dupixent are conjunctivitis (pink eye), keratitis, blepharitis, and dry eye, which affect the front surface of the eye rather than the optic nerve, located at the back of the eye 1.
Ocular Side Effects of Dupixent
- Conjunctivitis (pink eye) occurs in approximately 10% of patients
- Keratitis, blepharitis, and dry eye are less common eye-related side effects
- These conditions affect the front surface of the eye, not the optic nerve
According to a recent expert consensus on managing dupilumab-related ocular surface disorders in people with atopic dermatitis, there is no evidence that dupilumab induces a unique ocular surface disorder 1. The diagnosis of dupilumab-related ocular surface disorders (DROSD) is simply any ocular surface disease in a patient on dupilumab, and routine ophthalmological history and examination are recommended, as for the underlying ocular surface disease 1.
Management of Ocular Side Effects
- Patients with a history of ocular surface disease should be offered prophylactic treatment with lubricants at the outset of dupilumab therapy
- Close monitoring is essential for patients who develop severe or chronic disease
- If you experience any vision changes while taking Dupixent, such as blurred vision, eye pain, or vision loss, you should contact your healthcare provider immediately, and they may refer you to an ophthalmologist for evaluation 1.
However, it's essential to understand that the benefits of Dupixent for treating its approved conditions typically outweigh the risk of ocular side effects for most patients.
From the Research
Ocular Side Effects of Dupixent
- Dupixent (dupilumab) has been associated with various ocular side effects, including conjunctivitis, blepharoconjunctivitis, and limbal stem cell insufficiency 2.
- A systematic review of dupilumab-induced ocular surface disease (DIOSD) in patients with atopic dermatitis found that DIOSD occurs most frequently in patients with atopic dermatitis, and not in other skin conditions or in patients with asthma, chronic rhinosinusitis with nasal polyposis, or eosinophilic esophagitis who are on dupilumab treatment 3.
- Ocular side effects of dupilumab can be severe, and caution is advised if severe adverse events occur 2.
- Patients on dupilumab may have an increased risk of dry eye syndrome, keratoconus, cataracts, diffuse lamellar keratitis, viral keratitis, and perioperative infection, which should be considered when evaluating these individuals for corneal refractive surgery 4.
Optic Nerve Damage
- There is no direct evidence in the provided studies that dupixent causes optic nerve damage.
- The studies primarily discuss ocular surface disease, conjunctivitis, and other ocular side effects associated with dupilumab, but do not mention optic nerve damage specifically 5, 2, 3, 4, 6.
Treatment and Management
- Topical corticosteroids, tacrolimus, and artificial tears have been used to treat dupilumab-associated ocular surface disease, with partial or complete response in most patients 6.
- A symptom-based grading system has been proposed to guide non-ophthalmic physicians regarding ophthalmology consult for patients with dupilumab-associated ocular surface disease 6.