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Ocular graft-versus-host disease

Hessen, Michelle; Akpek, Esen K.

Current Opinion in Allergy and Clinical Immunology: October 2012 - Volume 12 - Issue 5 - p 540–547
doi: 10.1097/ACI.0b013e328357b4b9
EYE ALLERGY: Edited by Leonard Bielory and Stefano Bonini

Purpose of review This review was carried out to study the frequency, and severity of ocular surface involvement at the setting of allogeneic hematopoietic stem cell transplantation and subsequent graft-versus-host disease (GVHD) and evaluate the clinical outcomes of newer treatments.

Recent findings Ocular involvement has been reported in 60–90% of patients with chronic GVHD. Although dry eye is the most frequent finding occurring in the great majority of patients (up to 90%), posterior segment complications are also not infrequent, seen in 12.8% of patients after bone marrow transplantation. Anti-inflammatory treatments particularly T-cell suppressants seem to have a beneficial effect in managing GVHD. Corticoteroids, calcineurin inhibitors, such as cyclosporine and tacrolimus, as well as antifibrotic agents such as tranilast are available options for topical application. Cyclosporine ophthalmic drop seems to be a well tolerated and effective treatment modality; favorable results have been demonstrated with increased dosage.

Summary GVHD is an increasingly frequent cause of ocular surface morbidity with the potential of visual loss from corneal involvement. Early diagnosis and aggressive local as well as systemic treatment can be vision saving.

Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA

Correspondence to Esen K. Akpek, MD, 600 N Wolfe Street, Maumenee Building, Suite #317, Baltimore, MD 21287, USA. Tel: +1 410 955 5214; e-mail:

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.