Corneal Perforation Associated With Tralokinumab.

Objective: The purpose of this study was to report the first documented case of peripheral corneal perforation associated with tralokinumab therapy for atopic dermatitis.

Methods: A detailed clinical examination, imaging, and comprehensive systemic workup were performed to determine the etiology. The case was managed surgically and followed postoperatively at a tertiary hospital within the Spanish National Health System.

Results: We report the case of a 66-year-old woman receiving tralokinumab for atopic dermatitis who presented with a spontaneous 10 mm peripheral corneal perforation, self-sealed by iris prolapse. Urgent surgical intervention included corneal suturing and amniotic membrane grafting. There was no evidence of trauma, infection, systemic autoimmune disease, or periocular atopic dermatitis. A comprehensive systemic workup ruled out infectious and autoimmune etiologies. Tralokinumab was discontinued in coordination with the dermatology department. The patient experienced a favorable recovery, with complete corneal healing and improvement in best-corrected visual acuity to 0.1 logMAR at 3 months.

Conclusions: This case represents the first reported instance of corneal perforation potentially related to tralokinumab. Although ocular side effects of IL-13-targeted therapies are typically mild, this report highlights the possibility of severe complications. Given the increasing use of biologic agents in dermatology, awareness of rare but potentially vision-threatening adverse effects is essential. In suspected cases, early ophthalmologic evaluation and multidisciplinary management are crucial for preventing poor outcomes in patients receiving tralokinumab.