Graft Versus Host Disease, GVHD, is an immune mediated inflammatory reaction. It may occur in patients who have undergone bone marrow transplants is an immune mediated inflammatory reaction. It may occur in patients who have undergone bone marrow transplants. This reaction can affect several organs, including the skin, liver and the eyes. The eye is affected more commonly in patients who have chronic GVHD, but may be seen with the acute form of GVHD. This is called Ocular GVHD or GVHD of the eye.
What are the symptoms of Ocular Graft versus Host Disease?
Symptoms of Ocular GVHD can range from mild to severe. These may include one or more of the following symptoms:
- Dry eyes
- Foreign body sensation, and irritation
- Redness
- Excessive watering and tearing
- Intolerance to light
- blurred vision.
Often children who have had bone marrow transplants may not have any obvious complaints. Parents may, however, notice excessive eye rubbing and light sensitivity.
Remember, even vague symptoms like discomfort and scratchy eyes may be indicators of ocular GVHD, and so, must not be ignored.
Your transplant surgeon may want your eye doctor to rule out ocular GVHD even when you have no symptoms.
Diagnosis of Ocular GVHD
Your eye doctor will perform a complete eye examination including visual acuity testing, refraction, slit lamp examination and tear film assessment. She will also perform some special test for dry eye. These include Schirmers test, and staining of the cornea with Flourescien and/ or Rose Bengal dyes.
Treatment of Ocular GVHD
Basically, the management of dryness and prevention of infections and scarring of the eye are essential for management of Ocular GVHD.
The oral drugs that your bone marrow transplant surgeon will give for the rest of your body do not help much with the eyes. In fact, your eye doctor will suggest one or more of these options:
- Lubricating eye drops or tear supplements to increase eye comfort and minimize damage to the cornea
- Steroid eye drops to decrease inflammation and scarring
- Antibiotic eye drops to combat infections
- Autologous serum eye drops to help in healing and preventing scarring
- Cyclosporine eye drops to decrease the the immune mediated reaction
About the Author
This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine.
She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.
As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.
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