Graft Versus Host Disease (GVHD)
About Ocular Chronic Graft Versus Host Disease (GVHD)
Graft Versus Host Disease (GVHD) is a common side effect of a bone marrow, stem cell or cord blood transplant that is used to strengthen or restore the patient’s immune system during radiation or chemotherapy treatment for cancer and blood-related diseases, such as leukemia, lymphoma, neuroblastoma and multiple myeloma. GVHD is an autoimmune disease that can affect many different parts of the body including the skin, eyes, mouth, stomach and intestines. GVHD can range from mild to life-threatening. Approximately half of people who receive these types of transplants develop chronic GVHD. Chronic Ocular GVHD is a major complication that affects 60% – 80% of patients with chronic GVHD. Eye related symptoms include blurry vision, foreign body sensation, burning sensation, severe light sensitivity, chronic conjunctivitis (pink eye), dry eyes and eye pain.
Severe dry eye is the most common problem associated with GVHD. There is typically both a lack of aqueous tear formation and lack of oil secretion as a result of meibomian gland dysfunction (MGD). Patients really just stop making tears and are often painfully uncomfortable in addition to experiencing scarring of the cornea and eyelid positioning problems from scarring as well. This becomes even more irritating to the cornea, creating a cycle of dry eye problems.
Treatment and management of Chronic Ocular GVHD requires a corneal and eye immunology specialist to help patients to address the mix of symptoms by using a “stacked” treatment approach to achieve lubrication and tear preservation, reduction of inflammation, prevention of tear evaporation and drainage and support the epithelial tissue. This might require steroid eye drops, artificial tears, punctal plugs, cyclosporine eye drops (Restasis®), autologous serum eyedrops and trying nutritional supplements such as flaxseed oil or fish oil.