{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T10:11:42Z","timestamp":1771841502711,"version":"3.50.1"},"reference-count":41,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T00:00:00Z","timestamp":1771718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Dupilumab-related ocular surface disease (DROSD) is a significant safety challenge in atopic dermatitis (AD) management, potentially leading to treatment interruption despite cutaneous efficacy. This narrative review evaluates risk stratification and management strategies to standardize monitoring and preserve long-term drug persistence. Methods: A search of PubMed\/MEDLINE was conducted from inception to 31 December 2025. Evidence was synthesized from clinical trials, pooled safety analyses, and real-world registries, focusing on risk factors, monitoring tools, and interdisciplinary management algorithms for DROSD in AD populations. Results: Clinical trials identify conjunctivitis as a reproducible, context-dependent signal enriched in AD populations. Real-world data highlight that ocular symptoms disproportionately drive treatment dissatisfaction and discontinuation. Clinical vigilance must extend throughout the treatment course; while many cases appear early, a significant proportion develops between 8\u201316 weeks, with late-onset manifestations reported up to 12 months after initiation. Effective management relies on baseline risk documentation\u2014including prior ocular history and AD phenotype\u2014and the implementation of stepwise, severity-based \u201ctreat-through\u201d protocols. Conclusions: Managing DROSD is a critical strategy for maintaining treatment persistence. Integration of routine baseline risk capture, continuous symptom surveillance, and structured multidisciplinary escalation pathways is essential to maximize ocular safety and long-term therapeutic outcomes in AD.<\/jats:p>","DOI":"10.3390\/jcm15041651","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T08:58:21Z","timestamp":1771837101000},"page":"1651","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dupilumab-Related Ocular Surface Disease in Atopic Dermatitis: Risk Stratification, Monitoring, and Persistence-Preserving Management"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2781-6909","authenticated-orcid":false,"given":"Stefano","family":"Bighetti","sequence":"first","affiliation":[{"name":"Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4374-802X","authenticated-orcid":false,"given":"Luca","family":"Bettolini","sequence":"additional","affiliation":[{"name":"Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9449-849X","authenticated-orcid":false,"given":"Carlo Alberto","family":"Maronese","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, Universit\u00e0 Degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Macchi","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Pathophysiology and Transplantation, Universit\u00e0 Degli Studi di Milano, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7454-1999","authenticated-orcid":false,"given":"Zeno","family":"Fratton","sequence":"additional","affiliation":[{"name":"Institute of Dermatology, Department of Medicine, University of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0420-5009","authenticated-orcid":false,"given":"Vincenzo","family":"Maione","sequence":"additional","affiliation":[{"name":"Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9140-9263","authenticated-orcid":false,"given":"Mario","family":"Valenti","sequence":"additional","affiliation":[{"name":"Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Paolino","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Universit\u00e0 Vita-Salute San Raffaele, 20132 Milan, Italy"},{"name":"Dermatology Clinic, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8231-2205","authenticated-orcid":false,"given":"Andrea","family":"Carugno","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2986-1272","authenticated-orcid":false,"given":"Marco","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Center for Research in Medical Pharmacology, University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0935-7204","authenticated-orcid":false,"given":"Piergiacomo","family":"Calzavara-Pinton","sequence":"additional","affiliation":[{"name":"Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6800-3695","authenticated-orcid":false,"given":"Marina","family":"Venturini","sequence":"additional","affiliation":[{"name":"Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2177-9677","authenticated-orcid":false,"given":"Nicola","family":"Zerbinati","sequence":"additional","affiliation":[{"name":"Department of Medicine and Innovation Technology (DiMIT), University of Insubria, 21100 Varese, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariateresa","family":"Rossi","sequence":"additional","affiliation":[{"name":"Dermatology Department, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1093\/bjd\/ljae344","article-title":"An expert consensus on managing dupilumab-related ocular surface disorders in people with atopic dermatitis 2024","volume":"191","author":"Brown","year":"2024","journal-title":"Br. 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