What’s New in the Medicine Cabinet: AD and Ocular Comorbidities

In a recent interview with Dermatology Times, Jim Del Rosso, DO, a dermatologist based in Las Vegas, Nevada, provided key insights into the complex relationship between atopic dermatitis (AD) and ocular complications that he presented at Winter Clinical Miami. Drawing from his clinical experience and involvement in research, Del Rosso emphasizes the importance of addressing ocular comorbidities in patients with AD, particularly when managing the adverse effects of advanced biologic therapies.

Atopic Dermatitis and Ocular Comorbidities

Atopic dermatitis is often associated with ocular surface disease (OSD) and other eye-related issues. According to Del Rosso, "About 85% of patients with atopic dermatitis, not on these treatments, just with the disease, have ocular surface disease that they don’t necessarily know about." These cases may be subclinical, meaning patients may not report symptoms, or they may experience issues like decreased vision, irritation, or dryness without realizing the link to AD.

Ocular conditions such as conjunctivitis, cataracts, and glaucoma can occur due to the disease itself or as an adverse event of treatments, including topical corticosteroids and biologics. Del Rosso explains, "Every atopic dermatitis patient that comes into our office has a good chance of having some type of ocular disease that we as dermatologists are not going to know about." This highlights the need for collaboration between dermatologists and eye care specialists to ensure comprehensive care.

Therapeutic Landscape for AD

The treatment of AD has evolved significantly with the introduction of biologic therapies. Dupilumab, a monoclonal antibody targeting the interleukin-4 receptor, has been used for over 7years and has transformed care for many patients. However, Del Rosso notes, "In patients with atopic dermatitis, less so with prurigo nodularis where it’s approved, they can develop conjunctivitis. OSD and conjunctivitis are some of the ocular problems commonly associated with the disease itself and potentially related to therapy."

Other interleukin-13 inhibitors, such as tralokinumab and lebrikizumab, provide alternatives for patients who experience adverse effects or inadequate responses to dupilumab. Interestingly, Del Rosso points out, "There are several case reports where patients who developed conjunctivitis with dupilumab, when switched to an IL-13 inhibitor alone, responded well and did not have the same side effect." This suggests that therapeutic alternatives can address specific patient needs while minimizing ocular complications.

For patients seeking different mechanisms of action, Janus kinase (JAK) inhibitors, such as abrocitinib and upadacitinib, are emerging options. Additionally, Del Rosso stated nemolizumab, an interleukin-31 receptor inhibitor approved for AD and prurigo nodularis, has shown promise without being associated with conjunctivitis.

The Need for Regular Eye Exams

Del Rosso strongly advocated for routine eye exams for all AD patients, regardless of their treatment plan. He emphasizes, "It’s very important that if we have patients with atopic dermatitis, they get a periodic, good-quality eye exam, even if they’re not on therapy. Ocular comorbidities are so common and easy to forget about."

He further explains that primary care providers and dermatologists lack the tools and training to perform comprehensive ocular evaluations. Regular slit-lamp examinations by ophthalmologists or optometrists are crucial for detecting and managing conditions such as cataracts, glaucoma, or OSD.

Practical Recommendations for Ocular Care

To reduce ocular complications, Del Rosso recommends using preservative-free lubricating eye drops as a preventative measure. While acknowledging that consistent use can be challenging, he advises, "It’s a good idea to try to get people to use them regularly. Over-the-counter options are inexpensive and can help a lot of patients." 

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Click here for more insights from Del Rosso, including the full interview with Dermatology Times on his presentation at Winter Clinical 2025.