[Dry eye in graft-versus-host disease]

Abstract

Objective: To investigate patients who had ocular presentations after allogeneic hematopoietic stem cell transplantation.

Methods: The eyes of 20 patients of leukemia who had undergone allogeneic hematopoietic stem cell transplantation were examined. The ocular surface of these patients was examined by slit-lamp. The eye examination also included evaluation of tear break-up time, Schirmer tests with and without nasal stimulation, and fluorescein staining, rose bengal staining, etc. Conjunctival impression cytology and pathological examination of surgical specimens from 3 patients were performed.

Results: Fourteen of 20 patients developed chronic graft-versus-host disease (cGVHD). Eight patients suffered from dry eye accompanied by GVHD simultaneously. The incidence of dry eye in GVHD was 57%. Among them, 4 cases were severe dry eye associated with significant decrease of visual acuity and even development of corneal ulcer. Ophthalmic pathology findings were as follows: loss of conjunctival goblet cells or significant reduction in amount; conjunctival and corneal epithelial keratinization and squamous metaplasia; and dominance of T cell in conjunctival inflammatory infiltration cells.

Conclusion: Dry eye is the major ocular complication after allogeneic hematopoietic stem cell transplantation. It affected the patients' life quality severely. The high incidence and potentially severe ocular problems in these patients suggest that close ophthalmic monitoring is important in allogeneic hematopoietic stem cell transplantation.