Molecular dIagnostics to understand, prevent, and treat oCulaR COmorbidities in chronic skin disease (acronym; MICRO EYE

This project brought together researchers and doctors from dermatology and ophthalmology in a new public-private partnership with Leo Pharma to study why some patients with atopic dermatitis (AD) develop eye problems during treatment. Two common medicines for AD, dupilumab and tralokinumab, work well for the skin but can cause eye inflammation in some patients. Our goal was to better understand how these medicines affect the surface of the eye and how to prevent or treat side effects. 

Atopic dermatitis is a chronic inflammatory skin disease that affects about 10–20% of children and 2–10% of adults in the Netherlands. It often leads to itching, sleep disturbance, and poor quality of life. New biological treatments such as dupilumab and tralokinumab have improved care for many patients. However, up to 40% of patients on dupilumab develop eye inflammation, especially conjunctivitis. Understanding why this happens is important to improve patient safety and treatment outcomes. 

We examined the eye surface in patients before and during treatment, looking at cells, tear fluid, and gene activity. We found that atopic dermatitis itself already affects the eye’s surface, with fewer protective goblet cells and signs of inflammation. Dupilumab treatment reduced these cells even further and triggered immune changes that may explain the eye irritation. Tralokinumab had a milder effect and preserved the goblet cells better. We also developed a new laboratory model using patient-derived cells to test how different immune signals affect eye cells. This confirmed that IL-4 and IL-13, two important molecules in AD, are crucial for goblet cell development, while inflammation-related molecules like IFNγ can block this process. 

Our findings help doctors better recognize and manage eye symptoms in AD patients, support safer use of biologic therapies, and may lead to future treatments that protect the eyes while treating the skin.