Bilateral Peripheral Ulcerative Keratitis Associated with Dupilumab

Abstract

A 57-year-old woman without a history of connective tissue disorders started dupilumab (initial dose 600 mg) for atopic dermatitis. Ocular history was noncontributory, and the patient had undergone a normal eye examination recently. Ten days later, she developed bilateral ocular pain. Slit-lamp biomicroscopy revealed conjunctival injection and extensive peripheral corneal infiltrate bilaterally (Fig A, right eye; Fig B, left eye) with focal areas of ulceration (inset) consistent with peripheral ulcerative keratitis in both eyes. Dupilumab was discontinued. Frequent preservative-free tears, and later, prednisolone 1.0% four times daily were initiated. Peripheral ulcerative keratitis resolved after 3 weeks (Fig C, right eye; Fig D, left eye). Conjunctivitis occurs commonly in patients receiving dupilumab for atopic dermatitis; however, reports of an association with corneal ulceration are exceedingly rare (Magnified version of Fig A-D is available online at www.aaojournal.org).