Dupixent eye side effects: What they are and why they happen

In this article:

• How Dupixent works in the body
• Does Dupixent cause eye problems?
• Other Dupixent side effects
• How to manage eye problems and other Dupixent side effects
• Dupixent alternatives

In this article

• How Dupixent works in the body
• Does Dupixent cause eye problems?
• Other Dupixent side effects
• How to manage eye problems and other Dupixent side effects
• Dupixent alternatives

Eczema (atopic dermatitis) is one of the most common inflammatory skin conditions in the world. Hundreds of millions of people worldwide have to deal with the disease’s bouts of red, itchy, flaky skin, so it’s no wonder there’s a demand for effective medications. Dupixent (dupilumab) is one of the more recent options. It’s a monoclonal antibody drug that’s approved by the Food and Drug Administration (FDA) to treat and prevent eczema’s most bothersome symptoms. Although it can provide significant relief, it might also come with side effects—including ones that affect the eyes.

Not everyone will experience these adverse effects while taking Dupixent, but they’re possible. Read on for details on Dupixent and eye problems, including ways to manage them.

How Dupixent works in the body

Dupixent is a biologic drug, which means it’s created from living cells rather than synthetic chemicals. Biologics are designed to target specific immune system proteins that can cause certain reactions. For Dupixent, those proteins are interleukin-4 and interleukin-13, which trigger skin inflammation and other symptoms common with atopic dermatitis.

The immune system releases those proteins in response to potential allergens entering the body. While eczema’s exact cause is unclear, some researchers see it as an immune system and skin barrier condition, where the skin’s protective layers are more permeable than usual, allowing allergens to pass through. This causes the immune system to overreact, leading to skin irritation. By blocking interleukins-4 and -13, Dupixent helps curb this immune reaction, reducing or preventing the symptoms.

Administered as a subcutaneous injection, Dupixent isn’t a broad immunosuppressant like some biologics, so it doesn’t make patients more susceptible to serious infections.

Does Dupixent cause eye problems?

Interleukins-4 and -13 do more than just fight cellular invaders. They have multiple jobs in the body, and for interleukin-13, those jobs include stimulating goblet cells—which regulate mucus production on the surfaces of the eyes.

When goblet cells can’t keep the eyes lubricated, it can lead to various ocular surface diseases, including pink eye (conjunctivitis), eyelid swelling (blepharitis), corneal inflammation (keratitis), eye pruritus, and dry eye. Conjunctivitis is the most common side effect of Dupixent reported in clinical trials, according to Amy Huang, MD, a board-certified dermatologist with Medical Offices of Manhattan and contributor to LabFinder. In those clinical trials, 16% of patients reported conjunctivitis over a 52-week treatment period, making it the most prevalent side effect aside from injection site reactions.

Some outside studies have shown even higher rates of Dupixent eye side effects. For example, a systematic review from the American Academy of Dermatology found that conjunctivitis is the most commonly reported side effect of Dupixent overall, appearing in around 26% of subjects. Another study published in 2021 found an incidence of 32% among subjects for dupilumab-associated ocular surface diseases.

What’s confusing for patients is that these side effects don’t always appear right away, according to Yuna Rapoport, MD, the founder and CEO of Manhattan Eye. “The symptoms can come on either upon initiation of the medication or even when patients have been on the medication for years,” she says. However, she adds, “It does typically occur one to seven days after the injection.”

RELATED: Dupixent eye side effects

Other Dupixent side effects

Eye issues make up a significant chunk of the most common adverse effects, but there are a few others to know. Aside from ocular conditions, common side effects of dupilumab treatment include:

• Injection site reactions
• Joint pain
• Gastritis
• Toothaches
• Trouble sleeping
• Cold sores in the mouth or on the lips
• Facial rash or redness
• High white blood cell count (eosinophilia)

There’s a much smaller chance of serious side effects, but the following are also important to look out for:

• Severe allergic reactions
• Serum sickness (a kind of immune reaction)
• Swelling of the cornea (keratitis)
• Blood vessel swelling (vasculitis)

How to manage eye problems and other Dupixent side effects

There are several effective therapies for dupilumab-associated eye irritation, itching, and inflammation. “Typical treatment includes copious lubricating drops and ointment, prescription cyclosporine drops twice a day, a steroid drop, and often a low-dose tacrolimus ointment in and around the eyes,” Dr. Rapoport says.

The best option, however, depends on the severity of the symptoms. One study recommended beginning by seeing an ophthalmologist and starting a regimen of artificial tears or antihistamine eye drops.

But, if it’s a severe case, or if the first-line treatment doesn’t work, the researchers found some stronger options. They suggest a follow-up ophthalmologist appointment, during which the healthcare provider may reevaluate and prescribe other medications. Research has proven topical corticosteroids to be safe and effective for acute cases of allergic conjunctivitis. Cyclosporine eye drops are also a research-backed solution, as are tacrolimus eye drops, according to the American Academy of Ophthalmology.

“We don’t typically recommend discontinuing the medication, but rather dealing with the side effects,” Dr. Rapoport says. Yet, in particularly severe cases, some healthcare providers might still choose to discontinue Dupixent or find a suitable alternative.

Whether you’re using a mild or robust treatment, you can do certain things at home to provide relief and promote healing. Keeping the eyes clean is crucial, which means washing your hands, changing your towels and pillowcases, removing contact lenses if worn, and avoiding rubbing your eyes. Cool or warm compresses can also temporarily soothe itching and pain, while oral antihistamines or pain relievers might help as well. Dupixent doesn’t have reported interactions with antihistamines or pain relievers, but it’s best to ask a healthcare professional before taking any over-the-counter drugs or supplements.

Dupixent alternatives 

The thought of eye pain, redness, and itching might outweigh Dupixent’s potential benefits for some people, and that’s okay. If you’re hesitant to use Dupixent, there are some effective alternatives—including ones that rarely (if ever) affect the eyes.

Other monoclonal antibody drugs

Adbry is a common substitute for Dupixent because it works the same way. And while it can effectively treat moderate-to-severe atopic dermatitis, it also can cause some of the same side effects, including ocular ones. In the drug’s clinical trials, 7.5% of patients reported experiencing conjunctivitis. Fewer patients experienced keratoconjunctivitis (inflammation of the cornea and conjunctiva) and keratitis, but they’re still listed as common side effects.

JAK inhibitors

Some common JAK inhibitors prescribed for eczema include Cibinqo (abrocitinib), Opzelura (ruxolitinib), and Rinvoq (upadacitinib). These drugs have a different mechanism of action—blocking enzymes called Janus kinase instead of interleukins—so they have different possible side effects. For example, Cibinqo’s prescribing information doesn’t list ocular surface disease as a possibility. However, the label warns that, in very rare cases, it may cause partial retinal detachment.

Topical calcineurin inhibitors

As the name implies, topical calcineurin inhibitors like Elidel (pimecrolimus) and Protopic (tacrolimus) focus on blocking calcineurin, a protein that contributes to atopic dermatitis. They don’t present a risk of ocular side effects, but since they’re topical, they may cause irritation if they get into the eye during application.