Comment on: ‘Dupilumab-associated ocular surface disease: presentation, management and long-term sequelae’

Glaucoma and ocular surface disease (OSD) are often concomitant disorders (OSD is the consequence of a tear film dysfunction that may be due to several conditions). The aims of the paper are to suggest a sequence of diagnostic tests easy to perform in daily practice, both subjective and objective, to detect the onset of the OSD; and, second, to propose how to prevent and, if the case, how to manage the OSD. Briefly, tear film break-up time (TF-BUT) and corneal/conjunctival staining are suggested to detect the main signs of OSD. In terms of therapy, the long-term exposure to benzalkonium chloride (BAK) should be minimised, preferring non-BAK-preserved or BAK-free glaucoma medications, where available, as well as fixed combinations. The treatment of associated diseases of the anterior surface may reduce signs; use of non BAK-preserved tears may reduce symptoms.

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Effect of Autologous Serum Eyedrops on Ocular Surface Disease Caused by Preserved Glaucoma Eyedrops

Journal of Clinical Medicine ◽

10.3390/jcm9123904 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3904

Author(s):

Ha-Rim So ◽

Hae Young Lopilly Park ◽

So-Hyang Chung ◽

Hyun-Seung Kim ◽

Yong-Soo Byun

Keyword(s):

Ocular Surface ◽

Ocular Surface Disease ◽

Autologous Serum ◽

Ocular Surface Disease Index ◽

Ocular Surface Diseases ◽

Group 3 ◽

Baseline Values ◽

Group 2 ◽

Group 1

Autologous serum eyedrops (ASE) are effective in treating various ocular surface diseases, including damages induced by long-term use of preserved glaucoma eyedrops. However, there has been no study on whether ASE is effective without stopping the causative eyedrops. This retrospective observational study included 55 patients with ocular-surface diseases caused by long-term use of preserved glaucoma eyedrops: 18 patients who used ASEs for 2 months without discontinuing the use of glaucoma eyedrops (Group 1), 22 patients who used ASEs for 2 months, discontinuing the use of glaucoma eyedrops for the first month (Group 2) and 15 patients who used non-preservative artificial tears for 2 months, discontinuing the use of glaucoma eyedrops for the first month (Group 3). There were no intergroup differences in the baseline values of the Schirmer I test results, tear breakup time (TBUT), ocular surface staining (OSS) score, loss of the meibomian gland, meibum quality and ocular-surface disease index (OSDI). Group 1 showed significant differences in TBUT, OSS score and OSDI at 2 months when compared to the baseline values before treatment, while Group 2 showed significant differences in those values at both 1 and 2 months. There were no differences in any of the parameters at baseline, 1 month or 2 months in Group 3. Our result suggested that ASE is effective for treating ocular surface diseases caused by glaucoma eyedrops containing preservatives and its effects can be expected without interruption of glaucoma eyedrop treatment.

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Dupilumab-associated ocular surface disease: incidence, management and long-term sequelae

10.1101/2020.06.16.20124909 ◽

2020 ◽

Author(s):

Magdalena Z Popiela ◽

Ramez Barbara ◽

Andrew M J Turnbull ◽

Emma Corden ◽

Beatrice Suarez Matinez-Falero ◽

...

Keyword(s):

Ocular Surface ◽

Disease Incidence ◽

Ocular Inflammation ◽

University Hospital ◽

Ocular Surface Disease ◽

Prior History ◽

Topical Steroids ◽

Long Term Effects ◽

Skin Changes

AbstractObjectiveTo determine the incidence of ocular surface disease in patients with atopic dermatitis (AD) treated with dupilumab at a tertiary, university hospital. To describe the features of dupilumab-associated ocular surface disease, establish the need for treatment and report any long-term effects on the ocular surface.MethodsA retrospective analysis of consecutive patients treated with dupilumab for AD between January 2017 and August 2019 was undertaken. Data was collected on demographics, incidence and type of ocular disease features, natural history and treatment.Results50% (14/28) patients developed ocular symptoms with a mean time of onset of 6.75 (+/- 6.1) weeks from starting dupilumab. 69% of these (9/13) were diagnosed with conjunctivitis - associated with cicatrisation in two patients and periorbital skin changes in four. Of these nine, four had prior history of atopic keratoconjunctivitis. All were treated with topical steroids; two required additional ciclosporin drops. 67% (6/9) patients developed chronic ocular inflammation requiring maintenance drops at a mean of 16 (+/- 6.9) months of follow up. All patients had improvement in their AD severity; only one patient discontinued dupilumab due to ocular side effects.ConclusionThe rate of dupilumab-associated ocular surface disease was 32%. Periorbital skin changes and conjunctival cicatrisation were noted in association with conjunctivitis. Ocular surface disease improved on topical steroids and ciclosporin but 67% of patients needed on-going treatment. Patients should be referred to an ophthalmologist prior to starting dupilumab as a large proportion develops chronic ocular inflammation.

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How Ocular Surface Disease Impacts the Glaucoma Treatment Outcome

BioMed Research International ◽

10.1155/2013/696328 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 16

Author(s):

Snježana Kaštelan ◽

Martina Tomić ◽

Kata Metež Soldo ◽

Jasminka Salopek-Rabatić

Keyword(s):

Ocular Surface ◽

Microbial Contamination ◽

Standard Form ◽

Ocular Surface Disease ◽

Treatment Goals ◽

Corneal Epithelial ◽

Glaucoma Treatment ◽

Preservative Free

The treatment goals for glaucoma are lowering the intraocular pressure and preservation of vision. Topical hypotensive drops are the standard form of therapy which is often associated with some symptoms of toxicity, ocular inflammation, allergy, or ocular surface disease (OSD). OSD is a common comorbidity in glaucoma patients, and its prevalence with glaucoma increases with age. Use of topical treatment could additionally increase symptoms of OSD mostly due to preservatives added to multidose medication bottles used to reduce the risk of microbial contamination. This toxicity has been particularly associated with BAK, the most commonly used preservative which damages conjunctival and corneal epithelial cells and significantly aggravates OSD symptoms. OSD adversely affects patients’ quality of life causing discomfort and problems with vision which in turn may result in noncompliance, lack of adherence, and eventually visual impairment. In the management of glaucoma patients OSD symptoms should not be overlooked. If they are present, topical glaucoma treatment should be adapted by decreasing the amount of drops instilled daily, using BAK-free or preservative-free medication and lubricants if necessary. Awareness of the presence and importance of OSD will in turn improve patients' adherence and compliance and thus ultimately the preservation of long-term vision.

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Topical cyclosporine to control ocular surface disease in patients with chronic glaucoma after long-term usage of topical ocular hypotensive medications

Eye ◽

10.1038/eye.2015.40 ◽

2015 ◽

Vol 29 (6) ◽

pp. 808-814 ◽

Cited By ~ 8

Author(s):

M Saini ◽

R Dhiman ◽

T Dada ◽

R Tandon ◽

M Vanathi

Keyword(s):

Ocular Surface ◽

Ocular Surface Disease ◽

Chronic Glaucoma

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Dupilumab-associated ocular surface disease: presentation, management and long-term sequelae

Eye ◽

10.1038/s41433-020-01379-9 ◽

2021 ◽

Author(s):

Magdalena Z. Popiela ◽

Ramez Barbara ◽

Andrew M. J. Turnbull ◽

Emma Corden ◽

Beatriz Suarez Martinez-Falero ◽

...

Keyword(s):

Ocular Surface ◽

Past History ◽

University Hospital ◽

Ocular Surface Disease ◽

Prior History ◽

Topical Steroids ◽

Long Term Effects ◽

Skin Changes ◽

History Of

Abstract Objectives To determine the presenting features of ocular surface disease in patients with atopic dermatitis (AD) treated with dupilumab at a tertiary, university hospital. To establish the need for treatment of dupilumab-associated ocular surface disease and report any long-term effects on the ocular surface. Methods A retrospective analysis of consecutive patients treated with dupilumab for AD between January 2017 and August 2019 was undertaken. Data were collected on demographics, incidence and type of ocular disease features, natural history and treatment. Results A total of 50% (14/28) patients developed ocular symptoms with a mean time of onset of 6.75 (±6.1) weeks from starting dupilumab. Of these, 69% (9/13) were diagnosed with conjunctivitis associated with cicatrisation in two patients and periorbital skin changes in four. Of these nine, four had prior history of atopic keratoconjunctivitis. All were treated with topical steroids; two required additional ciclosporin drops. In all, 67% (6/9) patients went on to have on-going ocular inflammation requiring maintenance drops at a mean of 16 (±6.9) months of follow-up. All patients had improvement in their AD severity; only one patient discontinued dupilumab due to ocular side effects. Conclusion The rate of dupilumab-associated ocular surface disease was 32%. Periorbital skin changes and conjunctival cicatrisation were noted in association with conjunctivitis. Ocular surface disease improved on topical steroids and ciclosporin but 67% of patients needed on-going treatment. Close liaison with an ophthalmologist should be considered in those patients who develop conjunctivitis or have a past history of severe ocular surface disease.

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