Dupixent (dupilumab) is a targeted medication used to manage certain inflammatory conditions, including moderate-to-severe atopic dermatitis (eczema), asthma, and chronic rhinosinusitis with nasal polyps. This biologic drug works by blocking specific proteins involved in the body’s immune response, aiming to reduce inflammation and symptoms associated with these conditions. While offering significant relief for many patients, some individuals experience eye-related side effects, with conjunctivitis being a notable concern.
Understanding Dupixent-Associated Conjunctivitis
Dupixent-associated conjunctivitis refers to inflammation of the conjunctiva, the clear membrane that lines the inside of the eyelids and covers the white part of the eye. Common symptoms include redness, itching, watery eyes, and sometimes a discharge. Patients might also experience a gritty sensation in the eye, burning, or increased sensitivity to light. These ocular side effects can range from mild to moderate in severity, but some cases can become more serious if not managed appropriately.
The presentation of Dupixent-associated conjunctivitis may differ from typical allergic or bacterial conjunctivitis. It often involves persistent symptoms and can be accompanied by other eye issues like blepharitis (eyelid inflammation) or keratitis (corneal inflammation).
Why This Side Effect Occurs
The occurrence of conjunctivitis in some Dupixent users is thought to be linked to the drug’s mechanism of action. Dupixent works by blocking interleukin-4 (IL-4) and interleukin-13 (IL-13) signaling pathways, which are key drivers of type 2 inflammation in conditions like atopic dermatitis. These interleukins, however, also play a role in stimulating goblet cells in the eye, which produce mucus to keep the ocular surface lubricated. By blocking IL-13, Dupixent may inadvertently reduce the number of these goblet cells, leading to tear film instability and subsequent inflammation.
Conjunctivitis is a relatively common side effect, reported in up to 10% of patients across all indications in some studies. In clinical trials for atopic dermatitis, the incidence was notably higher, with some reports indicating it could be as high as 26% to 32% in atopic dermatitis patients. This side effect often appears several months after starting the medication, typically within four to six months.
Managing and Treating Dupixent Conjunctivitis
Managing Dupixent-associated conjunctivitis involves a range of strategies, from over-the-counter options to prescription medications, always under the guidance of a healthcare professional. For mild symptoms, artificial tears can help alleviate dryness and irritation, and preservative-free drops are often recommended. Applying warm, moist compresses to the eyelids for a few minutes can also provide comfort, and maintaining good eyelid hygiene with daily cleaning can be beneficial. Limiting contact lens use and wearing glasses, as well as protecting eyes from irritants like smoke or dust with sunglasses, can also reduce discomfort.
When over-the-counter remedies are insufficient, or symptoms are more severe, a doctor might recommend prescription treatments. These can include topical corticosteroids, which help reduce inflammation, or topical calcineurin inhibitors like tacrolimus or cyclosporine eye drops. These medications work by suppressing the immune response in the eye. A topical pimecrolimus cream applied to the eyelids has also shown effectiveness in some cases. Treatment should be tailored to the individual’s specific symptoms and severity, with ongoing communication with the prescribing doctor or an ophthalmologist.
When to Seek Medical Attention
It is important to seek medical attention for new or worsening eye symptoms while on Dupixent. Prompt review by a healthcare professional, such as the prescribing doctor or an ophthalmologist, is advised for any eye discomfort that persists or intensifies. Visual changes, such as blurred vision or increased sensitivity to light, also warrant immediate consultation.
Severe redness or swelling of the eyes, or symptoms that do not improve with initial over-the-counter treatments, should also prompt a medical evaluation. If there is significant eye pain that does not resolve, or any sudden changes in vision, urgent care may be necessary. Maintaining open communication with your healthcare team ensures ocular side effects are managed appropriately, allowing for continued Dupixent treatment while protecting eye health.