Ocular Findings of Pediatric Dry Eye Related to Graft-Versus-Host Disease

Abstract

Objectives: To evaluate the frequency and findings of dry eye associated with ocular graft-versus-host disease (GVHD) in pediatric hematopoietic stem cell transplantation (HSCT) patients. Materials and Methods: Retrospectively the records of pediatric patients with ocular GVHD were evaluated and ophthalmologic examination findings as well as Schirmer test results, tear film break-up time, and corneal staining grades were recorded. In severe dry eye patients topical cyclosporine-A was prescribed and the results were evaluated. Results: GVHD was detected in 51 (23.4%) of 218 HSCT patients, 4 of whom died during follow-up. Thirty (63.8%) of the remaining 47 patients had chronic ocular GVHD and 4 patients with severe dry eye were treated with topical cyclosporine-A with a median follow-up of 12.1 months. Severe dry eye symptoms and findings significantly improved in 2 patients. However, 1 patient had to stop treatment due to side effects. Conclusion: In children, chronic ocular GVHD is a common finding of GVHD after HSCT. Therefore, these patients should be examined periodically for dry eye.

Dry eye disease and risk factors for corneal complications in chronic ocular graft-versus-host disease

“…Several studies have reported a lower prevalence of systemic GvHD in pediatric cases when compared to adults. [ 10 , 21 , 22 ] This contrasts with our study where the proportions were similar in both the groups ( P = 0.97). Furthermore, the prevalence of dry eye has also been noted to be lower in pediatric patients, whereas in the present study, a similar severity and rate of progression were observed in both groups.…”

“…Furthermore, the prevalence of dry eye has also been noted to be lower in pediatric patients, whereas in the present study, a similar severity and rate of progression were observed in both groups. [ 10 , 23 , 24 ] These differences could be attributed to the variable racial and ethnic backgrounds of the samples in the existing literature. Hébert et al .…”

“…[ 4 , 7 , 8 ] Of these, keratoconjunctivitis sicca is the most common presentation of chronic ocular GvHD with nearly 60–80% of the cases developing this pathology. [ 7 , 10 , 11 ] Although several studies have described chronic ocular GvHD, most of this literature has originated from the West. This is in context of the fact that racial and ethnic differences impact both the type of presentation and overall survival rates in GvHD following HSCT.…”