Ocular surface disease is common in moderate‐to‐severe atopic dermatitis patients

High rates of ocular surface disease (OSD) in atopic dermatitis (AD) patients have been reported during dupilumab treatment. One of the hypotheses about the pathomechanism to be responsible for its development is focal scarcity of intraepithelial goblet cells. 1 An as sociation between moderate- to- severe AD patients and low goblet cell density (GCD) has also been reported previously. 2 Despite the association between AD and OSD reported in previous literature, moderate- to- severe AD patients do not commonly undergo ophthal mological evaluation. 2 To better understand the pathomechanism of dupilumab- associated OSD (DAOSD), more insight in the occurrence of OSD in moderate- to- severe AD population is needed. Therefore, we investigated the frequency, severity, and pathogenesis of OSD in moderate- to- severe AD patients before the start of dupilumab. This prospective study included adult moderate- to- severe AD patients treated with topical corticosteroids on the skin, between February 2020 and September 2021 from the University Medical Centre Utrecht, the Netherlands. The patients provided written in formed consent and were registered in the BioDay registry, which is co- funded by the manufacturer of dupilumab. 3 Ethics approval was obtained by the local Medical Research Ethics Committee. All patients were examined by a dermatologist and an ophthal mologist before starting dupilumab treatment. AD severity was assessed by the Eczema Area and Severity Index (EASI). Clinical oph thalmological characteristics and symptoms of OSD were reported. The patients were divided into having no, mild, moderate or severe OSD based on the Utrecht Ophthalmic Inflammatory and Allergic disease (UTOPIA) study in which two small subgroups were compared, we did not correct for multiple testing. Larger cohorts or other comparable studies are needed to support our results. In conclusion, this prospective, single- centre cohort study shows that OSD is a common finding in adult patients with moderate- to- severe AD and is associated with low conjunctival GCD, more severe AD, and the presence of facial AD and/or eyelid eczema. As many patients with OSD did not report OSD symptoms, low- threshold referral to an ophthalmologist is recommended in patients with the mentioned risk factors. The results of this study provide an important basis for unravelling the pathomechanism of ocular side- effects associated with IL- 4/IL- 13 blocking treatment in future studies.