Meibomian Gland Dysfunction in Ocular Graft vs. Host Disease: A Need for Pre-Clinical Models and Deeper Insights

Abstract

Despite decades of experience with hematopoietic stem cell transplantation, we are still faced with the delicate equipoise of achieving stable ocular health post-transplantation. This is because ocular graft-versus-host disease (oGvHD) following hematopoietic stem cell transplantation frequently occurs (≥50%) among transplant patients. To date, our understanding of the pathophysiology of oGvHD especially the involvement of the meibomian gland is still limited as a result of a lack of suitable preclinical models among other. Herein, the current state of the etiology and, pathophysiology of oGvHD based on existing pre-clinical models are reviewed. The need for additional pre-clinical models and knowledge about the involvement of the meibomian glands in oGvHD are emphasized.

Keywords: inflammation; meibomian glands; ocular graft-vs-host disease; pre-clinical models.

Figure 1

Schematic of the meibomian gland. Immature meibocytes reside at the periphery of acini and mature ones are central. Hyper-mature and lipid-laden meibocytes rapture and release meibum for upward delivery (short arrows) at the ocular surface.

Figure 2

Infrared meibography prior to aHSCT (a) OS of female patient, age 58, acute myeloid leukemia with normal distribution of meibomian glands, (b) OD of male patient, age 52, chronic myeloid leukemia with extensive loss of meibomian glands in both eyelids (Meibographer: Keratograph 5M, OCULUS Optikgeraete GmbH, Wetzlar, Germany).