Ocular Graft-Versus-Host Disease (GVHD) is a complication that can arise after an allogeneic hematopoietic stem cell transplant. This condition occurs when donated immune cells, intended to fight diseases like cancer, mistakenly identify the recipient’s healthy tissues as foreign and attack them. The eyes are a frequent target, significantly impacting quality of life following transplantation.
Understanding Ocular Graft-Versus-Host Disease
Graft-versus-host disease is an immune reaction where donor T cells from a transplanted bone marrow or stem cell graft attack the recipient’s tissues, causing inflammation and damage. The eyes are frequently affected by chronic GVHD, with ocular involvement occurring in 60% to 90% of patients who experience systemic GVHD.
The ocular surface is a common target for this immune attack. Impacted areas include the lacrimal glands, which produce tears, and the meibomian glands in the eyelids, responsible for producing the oily layer of the tear film. The conjunctiva, the clear membrane covering the white part of the eye and the inside of the eyelids, and the cornea, the transparent front part of the eye, are also commonly affected. Damage to these structures can lead to decreased tear production and an unstable tear film, resulting in persistent dry eye.
Identifying the Symptoms
Individuals with ocular GVHD experience various eye symptoms. Symptoms include persistent dryness, a gritty or foreign body sensation, and a burning feeling. Redness and pain are also reported, varying from mild to severe.
Light sensitivity (photophobia) and blurred vision are additional symptoms that can significantly affect daily activities. Some individuals may also notice excessive tearing or a mucous discharge. These symptoms can fluctuate in severity and impact comfort and daily activities.
Diagnostic Methods and Treatment Options
Diagnosing ocular GVHD involves a thorough eye examination by an ophthalmologist, who will assess the patient’s reported symptoms and conduct specific tests. The Schirmer’s test measures tear production by placing a small strip of filter paper in the lower eyelid. Ocular surface staining, using dyes like fluorescein or lissamine green, helps reveal damage to the cornea and conjunctiva.
Meibography, an imaging technique, allows for the evaluation of the meibomian glands for dysfunction or atrophy. These diagnostic tools help confirm the presence and severity of ocular GVHD. A diagnosis of chronic ocular GVHD often requires a history of allogeneic hematopoietic stem cell transplantation, self-reported dry eye symptoms, and signs of ocular surface disease like decreased tear production or corneal staining.
Treatment for ocular GVHD aims to alleviate symptoms, reduce inflammation, and protect the ocular surface. Initial approaches often involve frequent use of preservative-free artificial tears and lubricating ointments to maintain eye moisture. Topical anti-inflammatory eye drops, such as corticosteroids, cyclosporine, or lifitegrast, are commonly prescribed to control inflammation and improve tear function.
For more persistent dryness, punctal plugs can be inserted into the tear ducts to block tear drainage, keeping tears on the eye surface longer. Scleral lenses, custom-made rigid contact lenses that create a fluid reservoir over the cornea, can provide continuous hydration and protection, sometimes improving vision. In severe cases, surgical interventions like tarsorrhaphy (partially closing the eyelids) or corneal transplantation may be considered. Systemic immunosuppression may also be used, though topical treatments are often preferred to minimize side effects.
Living with Ocular GVHD
Managing ocular GVHD in daily life involves consistent self-care and adherence to medical recommendations. Maintaining a humid environment at home, using humidifiers, can help reduce eye dryness. It is also beneficial to avoid irritants such as wind, air conditioning, and smoke, which can exacerbate symptoms.
Proper eye hygiene, including warm compresses and gentle lid cleaning, can help manage symptoms like redness and crusting. Regular follow-up appointments with an ophthalmologist are important to monitor the condition’s progression and adjust treatments as needed. Patients should also discuss any other medications they are taking with their doctor, as some, like antihistamines or certain pain medications, can worsen dry eye symptoms.
While ocular GVHD can be a long-term condition, consistent management and collaboration with healthcare providers can help maintain eye health and improve overall quality of life. Incorporating omega-3 fatty acids through diet or supplements may also support tear production and alleviate dry eye symptoms.