Graft versus host disease: clinical evaluation, diagnosis and management

Graefes Arch Clin Exp Ophthalmol. 2013 May;251(5):1257-66. doi: 10.1007/s00417-013-2301-z. Epub 2013 Mar 17.

Abstract

Graft versus H\host disease (GVHD) can be a devastating complication following bone marrow transplantation. Acute or chronic systemic GVHD can be lethal, and severe damage of different organs and tissues can occur with both types of GVHD. Ocular involvement, either in an acute or chronic presentation, may range from mild to severe with accompanying vision loss present in 60-90 % of patients. Chronic ocular GVHD, the most common form of GVHD, affects mainly the lacrimal gland, meibomian glands, cornea and conjunctiva, mimicking other immunologically mediated inflammatory diseases of the ocular surface without specific symptoms or signs. However, dry eye disease is the main manifestation of GVHD. The long-term treatment of ocular GVHD continues to be challenging and involves a multidisciplinary approach wherein the ophthalmologist plays a major role. Besides systemic immunosuppression and ocular lubricants, topical steroids and topical cyclosporine are commonly prescribed. Newer therapeutic interventions for moderate and severe ocular GVHD include the use of serum eye drops and scleral contact lenses. In this manuscript, we review the mechanisms, clinical findings, and treatment of ocular GVHD.

Publication types

  • Review

MeSH terms

  • Bone Marrow Transplantation
  • Conjunctival Diseases / diagnosis
  • Contact Lenses
  • Corneal Diseases / diagnosis
  • Corneal Diseases / therapy
  • Dry Eye Syndromes / diagnosis
  • Dry Eye Syndromes / therapy
  • Eye Diseases / diagnosis*
  • Eye Diseases / therapy*
  • Eyelid Diseases / diagnosis
  • Eyelid Diseases / therapy
  • Glucocorticoids / therapeutic use
  • Graft vs Host Disease / diagnosis*
  • Graft vs Host Disease / therapy*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Lacrimal Apparatus Diseases / diagnosis
  • Lacrimal Apparatus Diseases / therapy
  • Lubricants / administration & dosage
  • Serum / physiology
  • Stem Cell Transplantation

Substances

  • Glucocorticoids
  • Immunosuppressive Agents
  • Lubricants