| Summary: | Rita Teixeira-Martins,1 Célia Araújo,1,2 Ana Faria Pereira,1 Inês Coelho-Costa,1 Amândio Rocha-Sousa,1,3 Jose Luís Plácido,4 João Pinheiro-Costa,5 Mário Lima-Fontes1,3 1Department of Ophthalmology; São João Local Health Unit, Porto, Portugal; 2Faculty of Medicine; University of Porto, Porto, Portugal; 3Department of Surgery and Physiology, Faculty of Medicine; University of Porto, Porto, Portugal; 4Department of Immunoallergology, São João Local Health Unit, Porto, Portugal; 5Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, PortugalCorrespondence: Rita Teixeira-Martins, São João Local Health Unit, Porto, 4202-451, Portugal, Email rita.teixeira.martins@ulssjoao@min-saude.ptPurpose: Dupilumab-associated ocular surface disease (DAOSD) is a reported side effect with several manifestations and uncertain risk factors. This study uses objective assessments and a patient-reported questionnaire to evaluate ocular surface disease (OSD) in Dupilumab-treated patients.Methods: A case-control study at São João Local Health Unit (ULS São João), Porto, Portugal, included 58 Dupilumab-treated adults categorized by the DAOSD Questionnaire. Cases (Group A, n=40) had ≥ 3 symptoms or ≥ 1 severe symptom, while controls (Group B, n=18) had < 3 symptoms without daily impact. Ocular surface parameters were assessed, including eye redness score, non-invasive break-up time (NIBUT), tear meniscus thickness, tear film stability evaluation (TFSE®), and tear osmolarity. The Ocular Surface Disease Index (OSDI) classified symptom severity.Results: Group A had significantly higher tear osmolarity (303.43± 7.61 vs 293.31± 5.11 mOsm/L, p
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