Graft Versus Host Disease and the Impact It Can Have on Your Eyes

Graft versus host disease is a common disorder that patients can experience following allogeneic hematopoietic stem cell transplantation, leading to a range of eye health problems.

Every year, thousands of patients receive allogeneic hematopoietic stem cell transplantation (AHSCT) to address hematological disorders. The reason this procedure works is that it helps encourage the immune system to attack malignant cells. However, this increased immune response for many patients causes additional health issues, including graft versus host disease (GvHD).

GvHD, which may be acute or chronic, results from an overactive inflammatory response, sometimes leading to the destruction of healthy tissues. Many patients (anywhere from 40% to 90%) with chronic GvHD will eventually develop symptoms that affect their eyes. Ocular GvHD can cause a range of symptoms and conditions, such as corneal ulceration, conjunctival scarring, and anterior uveitis (an inflammation of the middle layer of the eye that can cause redness, soreness, vision disturbances, and photosensitivity).

 

Eye Problems Associated with GvHD

GvHD can affect many parts of the eye, including:

 

• The lacrimal and meibomian glands. Chronic GvHD can damage the lacrimal glands. This damage can cause permanent stenosis (narrowing) of the duct, leading to moderate to severe dry eye. Damage to the meibomian gland can cause similar symptoms through excessive evaporation of the tears.
• The conjunctiva. Many with GvHD may experience some form of damage to the conjunctiva. Inflammation can lead to changes such as erythema or conjunctivitis. If this is not addressed, it can lead to atrophy or permanent loss of cells. Conjunctival inflammation is typically more severe in acute GvHD.

The cornea. Keratoconjunctivitis sicca can directly affect the cornea in GvHD which if not addressed can lead to ulceration, scaring and corneal melting in very severe cases. Symptoms range from mild blurring of vision or visual fluctuations to severe pain.

In GvHD,  dry eye can range from mild to  severe where it significantly affects daily activities and quality of life.

 

Treatment Options

The best treatment for GvHD is prevention. Treating ocular GvHD generally focuses on decreasing inflammation and increasing moisture. Prophylactic treatment centers on T-cell depletion or systemic immunosuppression. However, even with these preventive treatments, there may still be ocular damage. Some possibilities include:

 

• Most eye doctors will begin treatments conservatively using special eye drops and ointments. It’s important to seek advice from an eye care provider about what type of medications to use. Some of the products on the market can exacerbate symptoms or even cause further complications.
• Punctal plugs. Punctal plugs are small devices inserted into the tear ducts to stop fluid from draining away from the eye. This treatment can help keep the eyes moist and comfortable and relieve other dry eye symptoms. There are temporary and semi-permanent punctal plugs available. They may also be called lacrimal plugs or occluders.
• Topical treatments. Local topical corticosteroids or other drugs can help relieve symptoms and lower the overall risk associated with prolonged immunosuppression. However, these are typically recommended for short-term treatment, as long-term use can lead to problems such as cataracts, glaucoma, or corneal thinning.
• Scleral contact lenses. Scleral contact lenses are among the most effective treatment options for GvHD because they form a reservoir between the contact lens and the eye’s surface that helps keep the eye hydrated. Many patients who use scleral lenses report substantial relief of pain, light sensitivity, and other symptoms.

 

If you have GvHD and are experiencing unpleasant eye symptoms, there’s help available. Contact us for a consultation, and we’ll be happy to provide an exam and advice on your best treatment options.