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Graft vs Host Disease

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What is graft vs host disease of the eye?

Graft vs host disease (GVHD) of the eye occurs after transplants when donor cells attack the tissues and glands of the eye. GVHD can occur after a bone marrow or stem cell transplant. GVHD is an autoimmune disease which means the body overreacts to its own healthy tissue. It can affect different parts of the body including the eyes, skin, and intestines. The main targets of the donor cells in cases of ocular GVHD are the conjunctiva and lacrimal gland. The conjunctiva is the tissue that rests on top of the white part of the eye. The lacrimal gland is the main gland responsible for producing tears. Early in the disease process, inflammatory responses are the most apparent. This results in red and swollen glands and tissues. The inflammation prevents normal functioning of the targets involved, resulting in extreme dry eyes. Dry eyes can result in surface damage because lack of lubrication puts the eye in a position to be vulnerable to mechanical friction. In late disease states, scarring and damage to the front surface of the eye can occur. The result can be alterations to good vision and subsequent pain. Daily functions may become difficult due to the gritty feelings in your eyes. GVHD can occur in one or both eyes and may or may not involve symptoms within other parts of the body. Ocular symptoms are most commonly the presenting symptom of graft vs host disease. Therefore, regular eye exams are imperative in order to allow for early diagnosis and treatment. Your eye doctor will be able to help improve your quality of life and prevent irreversible eye damage.


What are some signs of ocular GHVD?

Graft vs Host disease within the eye results in dry eye as a result of meibomian gland obstruction and blepharitis. Scarring of the glands that are responsible for producing tears can also contribute to dry eye disease. Membrane or pseudo membrane formation may occur that can lead to red irritated eyes. Inflammation can lead to scarring and eventual damage to the cornea (front surface of the eye). Corneal findings include excessive thinning, perforations, and ulceration. This can lead to extreme pain and eventual vision loss.


What are some symptoms of ocular GHVD?

This condition presents similarly to other immune mediated inflammatory reactions within the eye. This presentation involves dry eye, redness, light sensitivity, eye irritation, blurry vision, and a feeling of something being in your eye. The most common presenting symptom of GHVD is the feeling of dry gritty or sandy eyes.


Management and treatment of GHVD

Treatment of GHVD most often involves reducing feelings of eye dryness in order to improve patient comfort. This can be done by using preservative free artificial tears. Lubrication of the eyes can improve symptoms and vision as well as prevent further damage to the front surface of the eye. These drops can be found at your local drug store, just look for preservative free on the bottle. Eye ointments and gels can be applied to the eye at night in order to keep your eyes moist while you sleep. In addition, immunosuppressant eye drops can be utilized to help reduce the body’s reaction. Cyclosporine or steroids are examples of these drops. Punctal plugs can be placed within your drainage system the same way a stopper plugs a drain in order to prevent tears from leaving the ocular surface. Therefore, this increases the number of tears available to the eye’s surface and improves overall lubrication. Serum eye drops can be formulated using the patient’s own blood in order to improve the efficacy of the drug, this is referred to as autologous serum eye drops. Bandage contact lenses can be used to provide a protective layer over the eye against the damage that can occur from dryness as well as pain that may occur. Bandage contact lenses can also promote healing in cases of corneal damage that have already occurred due to dryness. Scleral contact lenses may be a good option for patients who cannot find daily relief from dryness. This is due to the anatomy of the scleral lens, the larger diameter allowing for a pool of saline solution to rest over the cornea and beneath the lens. This provides a constant source of lubrication for the eye. Be mindful of the types of medications you are currently taking as some medications can exacerbate dry eyes. Some examples of these include antihistamines and antidepressants. Avoid dry climates and incorporate the use of humidifiers at home to improve moisture in the air.

The BostonSight PROSE is a type of scleral lens created for patients with ocular surface disease. It stands for Prosthetic Replacement of the Ocular Surface Ecosystem. This is an FDA approved lens that is designed specifically to restore vision. The PROSE is customized to fit the exact measurements of every nook and cranny of the surface of the patient’s eye. The personalized nature of the lens design improves the fit of the lens. This prevents damage to the eye from compression of the ocular surface. The PROSE functions like that of a scleral lens, resting on the white part of the eye with a fluid reservoir beneath it. This lens can be used throughout the day and removed before sleeping. A skilled practitioner that has been PROSE trained is required in order to properly fit patients with this lens. Speak to your eye doctor to see if this is a good option for you.


FREQUENTLY ASKED QUESTIONS ABOUT GHVD

Will GHVD result in blindness?

Vision in GHVD is typically not affected unless the front surface of the eye suffers damage. Blurry vision is common in dry eye conditions because of the rough surface of the cornea. If lubrication is improved via treatments discussed above, then sharpness of vision may be restored.

How does an optometrist diagnose ocular GVHD?

Your eye doctor will be able to diagnose ocular GVHD by performing a comprehensive eye exam in which they will rule out all possible causes of your symptoms. A thorough case history and clinical examination can help your eye doctor come to a final diagnosis. Dry eye symptoms will be evaluated with the use of special dyes that will help your eye doctor look for signs of front surface damage. Several tests can be run to determine the volume of tears you are producing versus average values.

Do bandage contact lenses correct my nearsightedness/ farsightedness?

Bandage contact lenses used in GVHD are similar to normal contact lenses, however they do not contain vision correction. Their main function is to protect the ocular surface, helping to restore function of the eye.

Will my dry eye ever get better or go away?

Unfortunately, graft vs host disease is a chronic condition. Therefore, symptoms of dry eye may be long lasting. Luckily, your eye doctor will be able to provide you with proper treatments that will improve that gritty sandy feeling and allow you to perform functions of daily living.