Ocular manifestations of graft-versus-host disease

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) has evolved over the past two decades to become the standard of care for hematologic and lymphoid malignancies. Major ocular complications after allogeneic HSCT have been increasing in number and severity. Graft-versus-host disease (GVHD) remains a major cause of ocular morbidity after allogeneic HSCT. The main objective of this review is to elucidate the ocular complications in patients developing GVHD following HSCT. Ocular complications secondary to GVHD are common and include dry eye syndrome, acquisition of ocular allergy from donors with allergic disorders. Eyelid changes may occur in GVHD leading to scleroderma-like changes. Patients may develop poliosis, madarosis, vitiligo, lagophthalmos, and entropion. The cornea may show filamentary keratitis, superficial punctate keratitis, corneal ulcers, and peripheral corneal melting which may lead to perforation in severe cases. Scleritis may also occur which can be anterior or posterior. Keratoconjunctivis sicca appears to be the most common presentation of GVHD. The lacrimal glands may be involved with mononuclear cell infiltration of both the major and accessory lacrimal glands and decrease in tear production. Severe dry eye syndrome in patients with GVHD may develop conjunctival scarring, keratinization, and cicatrization of the conjunctiva. Therapy of GVHD includes systemic immunosuppression and local therapy. Surgical treatment in refractory cases includes surgical intervention to improve the manifestation of GVHD of the eye. This may include tarsorrhapy, prose lenses, punctal occlusions and corneal transplantation.

Keywords: Graft-versus-host disease; Ocular; Transplantation.

Figure 1

Graft-versus-host-disease (GVHD) with keratoconjunctivitis sicca showing cutaneous changes with scleroderma-like skin lesions and areas of pigmentations and depigmentations.

Figure 2

Dry eye syndrome with entropion and loss of eyelashes in GVHD.

Figure 3

A 32 year-old male developed GVHD. He had bilateral conjunctivitis and dry eye syndrome.

Figure 4

Conjunctival cicatrization and shrinkage in a patient with GVHD.

Figure 5

An 18 year-old female who developed GVHD following bone marrow transplantation. Figure shows keratoconjunctivitis sicca and corneal filaments.

Figure 6

Peripheral corneal melting in a patient with GVHD and dry eye syndrome.

Figure 7

Labial Accessory salivary gland in a patient with GVHD showing mononuclear cell infiltration surrounding ductules with destruction of salivary acini.