Conjunctivitis

Conjunctivitis is inflammation of the conjunctiva, the thin membrane covering the white of the eye and the inside of the eyelids. It causes red, itchy, watery, sticky or sore eyes. Children with Atopic Dermatitis get it for several reasons. Allergic conjunctivitis often goes with Allergic Rhinitis and Pollen or House Dust Mites sensitisation. Eczema on the eyelids and eye-rubbing add irritation, and infections such as Herpes Simplex Virus can involve the eye. For toddler eczema, though, the term matters most as the commonest specific side effect of Dupilumab. Eye doctors call it dupilumab-associated ocular surface disease (DAOSD). It includes conjunctivitis, blepharitis (eyelid-margin inflammation) and keratitis (inflammation of the cornea).

Allergic Rhinitis [relates] Conjunctivitis Dupilumab [causes] Conjunctivitis

How often it happens in young children. In the 16-week LIBERTY AD PRESCHOOL RCT (6 months to 5 years), conjunctivitis affected 5% on dupilumab and none on placebo. No case was serious or led to stopping (Paller, Lancet 2022). Over 2 years of open-label use in under-6s, 19% had at least one episode. All were mild or moderate, lasted a median of 8 days, and none led to stopping (Paller, Pediatric Drugs 2026). In a large US database study of children up to 18 years (TriNetX; 9,919 matched per group, mean age 8.4), conjunctivitis within 1 year was 8.89% with dupilumab against 7.21% without (aHR 1.14). The relative increase was larger for blepharitis (aHR 2.21) and keratitis (aHR 2.66), though absolute rates stayed below 1% (Ayoubi, Ophthalmol Sci 2026). The FDA label carries a warning for conjunctivitis and keratitis, and the European Medicines Agency lists conjunctivitis among the most common side effects (up to 1 in 10).

LIBERTY AD PRESCHOOL [relates] Conjunctivitis FDA [regulates] Dupilumab

Why it happens. Dupilumab blocks the signalling of interleukins 4 and 13 (see Th2 Immune Response). IL-13 helps maintain the mucus-producing goblet cells of the conjunctiva. Blocking it is thought to cause goblet-cell and mucin loss and ocular surface inflammation. Children may be more vulnerable because their goblet cells and tear film are still maturing (Ayoubi 2026). In an Asian single-centre paediatric series, all 16 children who developed DAOSD (7.4% of 216 treated) had eyelid or head-and-neck eczema, and 31% had pre-existing eye problems (Pediatr Dermatol 2025).

Th2 Immune Response [relates] Conjunctivitis

What parents should watch for and how it is treated. Report new eye redness, itching, discharge, light sensitivity or eye pain to the prescribing team. These were the commonest presenting symptoms in the paediatric series. Management is usually lubricant (artificial tear) drops, sometimes with short courses of steroid or antihistamine/mast-cell-stabiliser eye drops from an ophthalmologist. In an Australian children’s hospital series, all 13 affected children received lubricants and 80% steroid drops. Final vision was good, and early ophthalmology review was advised (Cureus 2025). In the Asian series, most children used prophylactic lubricant drops. Two paused dupilumab, none had to stop, and eye problems took a median of 14 weeks to resolve. Pain, light sensitivity or reduced vision need same-day eye review, since keratitis and herpes infection of the eye can threaten sight.

Conjunctivitis [relates] Herpes Simplex Virus

Connections

• Dupilumab — caused by; main ocular adverse effect, source: Paller 2022/2026; FDA label
• LIBERTY AD PRESCHOOL — conjunctivitis 5% vs 0% on dupilumab at 16 weeks, source: Paller Lancet 2022
• Allergic Rhinitis — allergic conjunctivitis accompanies hay fever, source: Allergic Rhinitis note
• Th2 Immune Response — IL-13 blockade → goblet-cell loss, source: Ayoubi 2026
• FDA — label warning for conjunctivitis and keratitis, source: Dupixent PI 2026
• European Medicines Agency — conjunctivitis among most common side effects, source: Dupixent EPAR
• Herpes Simplex Virus — eye involvement needs urgent review, source: Dupixent PI (oral/HSV infections listed)