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Presentation type	E-poster
Title	Bilateral ocular surface inflammation during dupilumab therapy

Purpose	To describe bilateral ocular surface inflammation developing during prolonged dupilumab therapy and its clinical evolution.
Methods	A patient receiving dupilumab presented with two months of progressive bilateral ocular redness and swelling, without pain, discharge or visual loss. Clinical findings, microbiological investigations and response to treatment were documented.
Results	Initial examination showed marked tarsal and bulbar hyperemia, pronounced follicular conjunctivitis involving the bulbar conjunctiva, marked limbitis and moderate superficial punctate keratitis. The corneas were clear and the anterior chambers were deep and quiet without cells. Extensive microbiological testing, including bacterial cultures and PCR for adenovirus, Chlamydia trachomatis and Neisseria gonorrhoeae, was negative, as was viral culture. Topical dexamethasone led to marked clinical improvement, with resolution of the bulbar follicular reaction, near-complete resolution of limbitis and only mild conjunctival hyperemia at follow-up. A developing symblepharon and persistent inferior interpalpebral superficial punctate keratitis were noted. Dupilumab had been used for approximately 1–1.5 years and was continued.
Conclusion	The clinical presentation, negative infectious work-up and response to corticosteroids were compatible with dupilumab-associated ocular surface disease. However, causality could not be established as dupilumab was continued. This case highlights the importance of considering a drug-associated inflammatory etiology in bilateral conjunctivitis with a negative infectious work-up.
Conflict of interest	No

Authors 1

Last name	KEYTSMAN
Initials	E
Department	UZ Brussel
City	Jette

Authors 2

Last name	Salman
Initials	S A
Department	UZ Brussel
City	Jette