Download Ocular Graft versus Host Disease

Inflammatory Eye Disease
Ocular Graft versus Host Disease
Graft versus Host disease occurs in people who have had a bone marrow transplant. It is
caused by lymphocytes (which are one of the white blood cells that are received in the
transplant). In patients who have had a bone marrow transplant, the lymphocytes from the
donor sometimes attack the body of the person who has received the transplant.
Normally our lymphocytes fight foreign infections and tumours in our body. This is "Graft
Versus Host Disease". This commonly affects the skin and the mucous membranes (moist
surfaces of our eyes, mouth and gut) and it may affect other organs.
How does Graft versus Host disease affect the eye?
The conjunctiva, or the moist skin overlying the front of the eye, is commonly attacked in
Graft versus Host disease. This attack may take two forms. Firstly the eye may become very
inflamed, red and sore. Secondly and more commonly, the attack is chronic and gradual. In
this case the ability of the eye to produce enough tears to protect it is reduced. This usually
causes the eye to be persistently dry or irritated; especially in dry environments such as an
air conditioned room or a smoky room, or on dry hot days. Very rarely the bone marrow
transplant may cause damage to the retina, which affects vision. The prednisolone used as
treatment for Graft versus Host disease may affect the inside of the eye and may cause a
cataract.
How is ocular Graft versus Host disease treated?
If the Graft versus Host disease is severe and particularly if it affects organs other than the
eye, then it will require treatment with immunosuppressive medication such as
Prednisolone or Cyclosporin. There are specific treatments for the ocular effects of Graft
versus Host disease. If the eyes are very inflamed, then topical steroids are used to dampen
the inflammation. If the eyes are dry, then long term topical lubricants (eye drops or
ointment) are used to replace the tear film. It is also best to avoid environments that are
known to be dry or irritating to the eyes, such as air conditioned rooms or planes or smoke
filled rooms. If these measures are not enough, then it is possible to have minor surgery to
prolong the duration of any drops or tears that happen to be in the eye. Occasionally the use
of humidifiers to humidify the air in a room where the patient spends a lot of time will be
useful.
What is the long-term outlook?
The inflammation associated with Graft versus Host disease nearly always settles in the
long term. Unfortunately the dry eyes usually persist even when the Graft versus Host
disease itself has settled. This is because the damage to the conjunctiva (moist skin over the
eyes) is often permanent. This means that long term tear replacement is often needed. If
you have any questions, don't hesitate to speak to your eye doctor about your problems.
Consultation
Should you require a consultation for Inflammatory Eye Diseases, please call 1800 986 695
At Eye Surgery Associates we are able to offer you appointments at any one of our three
sites: East Melbourne, Malvern and Doncaster.
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