Dupilumab (brand name Dupixent) is a biologic medication — a monoclonal antibody that blocks the signalling pathways driving type 2 inflammatory conditions. It is prescribed for moderate to severe atopic dermatitis (eczema), asthma, chronic rhinosinusitis with nasal polyps, and several other conditions.

For many patients it produces dramatic improvements in skin and respiratory symptoms. However, ocular side effects occur in a significant proportion of users — estimates vary across studies but figures of 10 to 50 percent have been reported depending on the definition used and the population studied.

Why does dupilumab affect the eyes?

The precise mechanism is not fully understood, but several explanations have been proposed:

• Altered conjunctival immune environment — dupilumab blocks IL-4 and IL-13 signalling, which plays a role in maintaining the normal conjunctival mucosal immune balance. Disrupting this may promote a different inflammatory pattern on the ocular surface
• Goblet cell disruption — IL-13 signalling is involved in goblet cell function. Goblet cells produce mucin, a critical component of the tear film. Reduced goblet cell activity may destabilise the tear film
• Pre-existing ocular surface vulnerability — patients with atopic dermatitis often have pre-existing eyelid disease, blepharitis, and ocular surface changes before starting dupilumab, making them more susceptible to ocular side effects
• Demodex — there is emerging evidence of an association between dupilumab use and Demodex blepharitis, though the relationship is still being characterised

What are the symptoms?

Dupilumab-associated ocular surface disease presents across a spectrum — from mild irritation to significantly symptomatic conjunctivitis:

• Redness of the eyes and eyelid margins
• Itching — often prominent and distressing
• Burning or stinging
• Watery or discharge from the eyes
• Crusting of the lids, particularly on waking
• Dry, gritty, or uncomfortable eyes
• Sensitivity to light
• Blurred vision
• Swelling or thickening of the eyelid margins

Symptoms typically develop within the first weeks to months of starting dupilumab and may fluctuate over time. In some patients they resolve with ongoing treatment; in others they persist for as long as the medication is continued.

How is dupilumab ocular surface disease assessed?

Assessment at our clinic includes a thorough examination of all the relevant ocular surface components:

• Slit lamp examination — detailed assessment of the conjunctiva, lid margins, cornea, and tear film
• Meibomian gland imaging and expression — identifying MGD, which is common in this patient group
• Demodex assessment — examining for collarettes and signs of infestation, given the emerging association with dupilumab use
• Tear film stability — assessing the quality and stability of the tear film
• Goblet cell assessment — indirect assessment through tear film mucin analysis
• Symptom scoring — quantifying severity and tracking response to treatment
• Full medication and history review — including when dupilumab was started, how symptoms developed, and what treatments have already been tried

We also review whether there are any modifiable factors — including application technique and injection site — that might be contributing.

How is dupilumab ocular surface disease treated?

Management is tailored to the specific pattern of disease identified at assessment. The evidence base is still developing, but several approaches have demonstrated benefit.

Topical anti-inflammatory treatment Topical cyclosporine and corticosteroid drops are commonly used in more significant presentations. Where these are indicated, we'll discuss with you and liaise with your prescribing physician or dermatologist as appropriate.

Treating underlying MGD and lid disease Many patients have pre-existing meibomian gland dysfunction or blepharitis that dupilumab has unmasked or worsened. Treating the gland disease directly can produce significant improvement:

• IPL therapy — reduces lid margin inflammation and improves meibomian gland function. Evidence from Farrant et al. 2025 and other work supports IPL as an effective intervention in dupilumab-associated ocular surface disease
• LLLT — anti-inflammatory photobiomodulation addressing lid margin disease and supporting gland function
• ZEST — where Demodex infestation is identified, deep professional lid cleaning is an important part of management
• Meibomian gland expression — in-clinic clearance of blocked glands following warming treatment

Tear supplementation Preservative-free lubricating drops and gels help manage surface dryness and provide symptomatic relief alongside disease-modifying treatments.

Lid hygiene A structured daily lid hygiene routine reduces bacterial load and helps maintain the results of in-clinic treatment.

Communication with your prescribing team Dupilumab-associated ocular surface disease should be communicated to the prescribing dermatologist or respiratory physician. In most cases the medication should not be stopped — the systemic benefits usually outweigh the ocular side effects, which are manageable with appropriate treatment. However, your prescribing team should be aware and involved in the overall management plan.

Should I stop taking dupilumab?

This is a decision for you and your prescribing physician — not one we would make unilaterally. For most patients, dupilumab is providing significant benefit for their skin or respiratory condition, and stopping it is not the right answer.

What we would say is that ocular side effects should not be left unmanaged on the assumption that they'll resolve on their own, or accepted as an inevitable cost of the medication. With appropriate treatment, most patients achieve good control of their eye symptoms while continuing dupilumab successfully.

Frequently asked questions

How common are eye problems with dupilumab? Studies report rates varying from around 10 to 50 percent depending on the population and definitions used. It is one of the most frequently reported side effects of the medication.

Will my eye symptoms get better if I stop dupilumab? For many patients, ocular symptoms improve after stopping the medication — but this has to be weighed against the systemic consequences of stopping a treatment that may be controlling significant eczema or asthma. This decision should be made with your prescribing physician.

My dermatologist said my eye problems aren't related to dupilumab — could they still be? Awareness of dupilumab-associated ocular surface disease has grown significantly in recent years but is not yet universal across all specialties. If your eye symptoms developed or worsened after starting dupilumab, the association is worth taking seriously regardless of what you've previously been told.

Can the eye problems be treated without stopping the medication? Yes — in most cases effectively so. Treatment targets the ocular surface disease directly rather than requiring the medication to be stopped.

Do I need a referral? No. You can book directly with us. We will liaise with your prescribing team where appropriate as part of your management.

Get specialist support for your eyes

If your eyes have been affected since starting dupilumab, a specialist dry eye assessment will identify exactly what's happening on your ocular surface and what the most effective treatment approach will be.

📍 Openshaw Opticians, Unit 4, 16 Cheapside, Cleckheaton, BD19 5AF 

📞 01274 878214