Why does Dupixent cause eye problems?

Dupixent (dupilumab) is associated with several different eye problems, including conjunctivitis, blepharitis, dry eyes, itchy eyes, and keratitis. The cause of the eye problems is likely to be the same mechanism that makes Dupixent effective against eczema, asthma, COPD, rhinosinusitis, esophagitis, and prurigo nodularis.

Dupixent is a human monoclonal IgG4 antibody that works by blocking two inflammatory proteins, called interleukin-4 (IL-4) and interleukin-13 (IL-13). Unfortunately, goblet cells, which are responsible for creating mucus in the eye and ensuring the stability of tears, are also stimulated by IL-13. So, when Dupixent blocks IL-13 which helps resolve the symptoms of the conditions it is approved for, it also lowers the numbers of epithelial goblet cells, leading to inflammation and eye problems.

Most of the time the inflammation is not too severe, but in some people, Dupixent may need to be discontinued. Most eye problems respond to standard treatments, for example, antibacterial eye drops for bacterial conjunctivitis or eye lubricants for dry eye. Eye problems reported with Dupixent include:

• Conjunctivitis (inflammation of the conjunctiva [the lining of the eye] due to allergic, bacterial, or viral causes), giant papillary conjunctivitis, eye irritation, and eye inflammation. Reported by 10% of people
• Itchy eyes. Reported by 1% of people
• Dry eye. Reported by less than 1% of people
• Blepharitis (inflammation along the edges of the eyelids). Reported by less than 1% of people
• Keratitis (inflammation of the cornea). Reported by less than 1% of people.