Summary about Disease
Ocular Graft-versus-Host Disease ( глаз GVHD) is a complication that can occur after hematopoietic stem cell transplantation (HSCT), also known as bone marrow transplant. In ocular GVHD, the donor's immune cells (the graft) recognize the recipient's tissues (the host), including the eyes, as foreign and attack them. This can lead to inflammation and damage to the ocular surface, tear glands, and other eye structures, causing a range of symptoms from mild dryness to severe vision impairment.
Symptoms
Symptoms of ocular GVHD can vary in severity and may include:
Dry eyes (most common)
Burning or stinging sensation
Gritty or foreign body sensation
Redness
Light sensitivity (photophobia)
Blurred vision
Excessive tearing (paradoxical tearing due to dryness)
Pain
Eyelid swelling
Corneal ulcers or scarring
Causes
Ocular GVHD is caused by an immune reaction following HSCT. Donor immune cells (T cells) recognize the recipient's eye tissues as foreign and initiate an inflammatory response. This immune response can damage the tear glands (leading to dry eye), the conjunctiva, cornea, and other parts of the eye. Risk factors for developing ocular GVHD include:
Severity of systemic GVHD
Type of transplant (allogeneic vs. autologous)
Human leukocyte antigen (HLA) mismatch between donor and recipient
Previous GVHD
Medicine Used
Treatment for ocular GVHD aims to reduce inflammation, alleviate symptoms, and prevent further damage. Common medications include:
Artificial tears: To lubricate the eyes and relieve dryness (e.g., carboxymethylcellulose, hyaluronic acid).
Topical corticosteroids: To reduce inflammation (e.g., prednisolone acetate, fluorometholone). Use is usually short-term due to potential side effects.
Topical calcineurin inhibitors: Such as cyclosporine or tacrolimus eye drops, to modulate the immune response.
Systemic immunosuppressants: In more severe cases, medications like cyclosporine, tacrolimus, or mycophenolate mofetil may be used to suppress the overall immune system.
Punctal plugs: To block the tear ducts and increase tear film volume.
Autologous serum eye drops: Eye drops made from the patient's own blood serum, containing growth factors and other components that can promote corneal healing.
Amniotic membrane transplantation: In severe cases with corneal damage.
Scleral lenses: Therapeutic contact lenses that protect the cornea and provide lubrication.
Is Communicable
Ocular GVHD is not communicable. It is an immune-mediated reaction that occurs within the recipient's body after a transplant and cannot be transmitted to another person.
Precautions
While ocular GVHD itself isn't contagious, individuals with the condition should take precautions to protect their eyes and manage their symptoms:
Strict adherence to prescribed medications: Follow the ophthalmologist's instructions carefully regarding medication use and dosage.
Avoid irritants: Minimize exposure to smoke, dust, wind, and other environmental irritants.
Humidify the environment: Use a humidifier to keep the air moist, especially in dry climates or during winter.
Wear sunglasses: Protect eyes from sunlight and glare.
Regular eye exams: Schedule regular check-ups with an ophthalmologist to monitor the condition and adjust treatment as needed.
Good eyelid hygiene: Clean eyelids regularly to remove debris and reduce inflammation.
Avoid rubbing eyes: This can worsen inflammation and irritation.
How long does an outbreak last?
The duration of an ocular GVHD "outbreak" or episode can vary significantly. Some patients may experience chronic, ongoing symptoms, while others may have periods of flare-ups followed by periods of remission. The course of the disease depends on the severity of the GVHD, the effectiveness of treatment, and individual patient factors. It can persist for months to years.
How is it diagnosed?
Diagnosis of ocular GVHD typically involves:
Comprehensive eye exam: An ophthalmologist will examine the eyes for signs of dryness, inflammation, corneal damage, and tear gland dysfunction.
Review of medical history: Including history of HSCT and systemic GVHD.
Tear film tests: Schirmer's test to measure tear production, tear breakup time (TBUT) to assess tear film stability.
Corneal staining: Using dyes such as fluorescein or lissamine green to identify areas of corneal or conjunctival damage.
Impression cytology: Collecting cells from the conjunctiva for microscopic examination to look for inflammatory markers.
In vivo confocal microscopy: A non-invasive imaging technique to examine the cornea at a cellular level.
Timeline of Symptoms
Ocular GVHD symptoms can appear at different times after HSCT:
Acute GVHD: Typically develops within the first 100 days after transplant.
Chronic GVHD: Usually develops after 100 days post-transplant, but can also occur later. Symptoms can develop gradually or suddenly. The exact timing and progression of symptoms vary from person to person. The initial symptoms are often mild and may be overlooked.
Important Considerations
Early diagnosis and treatment are crucial: Prompt intervention can help prevent severe complications and vision loss.
Multidisciplinary approach: Management of ocular GVHD often requires collaboration between ophthalmologists, hematologists/oncologists, and other specialists.
Individualized treatment: Treatment plans should be tailored to the individual patient's symptoms and disease severity.
Long-term monitoring: Regular follow-up with an ophthalmologist is essential to monitor for disease progression or complications.
Impact on quality of life: Ocular GVHD can significantly impact quality of life due to discomfort, vision impairment, and treatment burden. Support groups and counseling may be helpful.
Clinical trials: Consider participation in clinical trials evaluating new treatments for ocular GVHD.