Graft Versus Host Disease
Graft-Versus-Host disease (GVHD) is a common side effect of an allogeneic (donor source) bone marrow, stem cell or cord blood transplant. In rare cases, it can result from blood transfusions. Approximately half of people who receive allogeneic transplants develop chronic GVHD. GVHD is an autoimmune disease that can affect many different parts of the body; the skin, eyes, mouth, stomach and intestines are affected most often. GVHD can range from mild to life-threatening.
Ocular GVHD is a major complication that affects 60% – 80% of patients with chronic GVHD. Eye related symptoms include blurry vision, foreign body sensation, burning sensation, severe light sensitivity, chronic conjunctivitis (pink eye), dry eyes, and eye pain.
Signs and Symptoms of Graft Versus Host Disease
- New-onset dry, gritty, or painful eyes
- Photophobia – light sensitivity
- Difficulty opening the eye because of dried mucoid secretions
- Excessive tearing – watery dry eyes
- Blepharitis – eye infections
- Keratoconjunctivitis sicca- severe dry eyes
Incidence of Dry Eyes in Graft Versus Host Disease
The incidence of dry eye syndrome in GVHD varies from 22 to 80 percent. The most common complaints in patients with KCS are: foreign body sensation, ocular dryness and grittiness, conjunctival hyperemia, mucoid discharge (sticky stringy discharge) and excessive tearing (watery dry eyes).
Management and Diagnosis of Graft Versus Host Disease
- GVHD is systemic, so diagnosis and management of ocular GVHD should be approached in a multidisciplinary fashion.
- The major issue in ocular GVHD is dry eye syndrome. Pre-transplantation ophthalmic examination and Schirmer testing is recommended. Treatment with TheraLife® Autoimmune, punctal plugs and even topical cyclosporine or corticosteroid, depending on severity, can slow progression of eye problems.
- In the case of pseudomembrane formation, early debridement and topical corticosteroid and cyclosporine use are encouraged.
- Many ocular GVHD exacerbations occur during the tapering of systemic immunosuppressive therapy. Attention to topical treatment, especially pulsed corticosteroids and cyclosporine, is necessary to avoid serious systemic side effects.
Treatments for Chronic Dry Eyes Due to Graft Versus Host Disease
Treatment for chronic dry eyes in graft vs. host disease is multi-faceted. Due to the severity of graft vs. host disease, it must be noted that steroid drugs and antibiotics are used heavily in addition to typical treatments for chronic dry eye disease.
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