Graft versus Host Disease: Eyes

Summary: Ocular graft-versus-host disease (GVHD) can cause tear loss, dry eyes, irritation, pain and vision problems and can impact quality of life after transplant. This presentation will discuss symptoms of ocular GVHD and effective treatments.
Presenter: Todd Margolis MD, PhD, Washington University School of Medicine
Many thanks to Incyte and Sanofi whose support helped make this Survivorship Symposium possible.
To read the transcript, go to:
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Highlights:
Topical therapies for ocular GVHD, such as artificial tears, treat only the symptoms, not the GVHD that is causing the symptoms. Systemic GVHD must be controlled in order for topical therapies to be effective.
If you use tear drops throughout the day, be sure to avoid touching parts of your eyes to avoid irritation or an infection. Avoid “get the red out” eye drops, which can be toxic.
A variety of therapies are available to treat the symptoms of ocular GVHD, some of which are costly and have unproven effectiveness. Consult an ophthalmologist who is a corneal specialist with GVHD experience to help you properly manage your ocular GVHD. You can consult BMT InfoNet's GVHD Directory to locate a physician who has experience treating ocular GVHD.
April 2024, Part of the Virtual Celebrating a Second Chance at Life Survivorship Symposium 2024
Presentation is 40 minutes long with 19 minutes of Q & A.
Key Points:
(04:38): Parts of the eye often affected by GVHD include the lacrimal glands, cornea, conjunctiva and meibomian glands.
(06:43): Primary ocular GVHD is an attack by donor immune cells on the lacrimal gland and conjunctiva causing inflammation. Systemic immunosuppression is required to treat it.
(08:18): Secondary ocular GVHD are the symptoms that remain after primary GVHD has subsided, They most often treated by topical medications such as artificial tears and steroids.
(11:11): Lack of tears due to ocular GVHD can cause strands of mucous called corneal filaments on the cornea which can be painful.
(11:53): Tear loss can cause keratinization - drying of the membrane that covers the cornea. This can cause irritation, thinning of the cornea and infection.
(21:27): It’s important to insert an eye lubricant properly, without touching the eye, to avoid irritation and infection.
(23:13): Another strategy to treat tear loss is to block tear drainage with temporary punctal plugs, or by surgically closing the openings that pump out tears (the puncta).
(24:06) Eye evaporation can be reduce by wearing goggles, taping the eye closed at night or sewing portions of the eyelids together.
(26:25): Scleral contact lenses, which reduce discomfort and improve vision, can be a real game-changer for some patients.
(29:50): There are a lot of costly therapies that are of questionable value including serum eye drops, amniotic membranes, topical cyclosporine, Xiidra, meibomian gland therapies, and omega-three supplements.
Meet the speaker:
ophthalmology.wustl.edu/peopl...
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