• Muhammad Aamir Arain
  • Muhammad Khizar Khizar Niazi
  • Muhammad Dawood Khan
  • Parvez Ahmed
  • Muhammad Afzal Naz
  • Muhammad Fayyaz


Background: With the advancement of techniques for haematopoietic cell transplantation, thenumber of transplant survivors is increasing rapidly and so are the chances of chronic graft versushost disease (cGVHD). The ocular manifestations of this disease have not been explored in ourlocal population. This study was conducted to determine the frequency of ocular complications incases of cGVHD following successful bone marrow transplantation. Methods: Twelve diagnosedcases of cGVHD were evaluated from June 2008 to March 2009 and there ocular manifestationswere noted especially the ocular surface disorders, using double staining method with fluoresceinand rose-bengal. Results: Nine patients (75%) were having dry eyes, 7 (58.3%) with mebomianglands dysfunction, 4 (33%) with acute conjunctivitis, 2 (16.7%) with bilateral lacrimalcanalicular occlusion, and 1 (8.3%) each of bilateral posterior subcapsular cataract, unilateralsterile corneal epithelial defect, anterior uveitis, retinal haemorrhages and disc oedema.Conclusion: The higher frequency of dry eyes along with other ocular manifestations in patientsof cGVHD suggests the need of close ophthalmic monitoring in all such cases.Keywords: Dry eyes, chronic graft versus host disease, haematopoietic cell transplantation


Horowitz MM. Uses and growth of hematopoietic cell

transplantation. In: Blume KG, Forman SJ, Appelbaum FR,

eds. 3rd ed. Thomas’ Hematopoietic Cell Transplantation.

Oxford: Blackwell Science; 2004.p.9–13.

Sullivan KM. Graft-versus-host disease. In: Blume KG,

Forman SJ, Appelbaum FR, eds. 3rd ed. Thomas`

Hematopoietic Cell Transplantation. Oxford: Blackwell


Shulman HM, Sullivan KM, Weiden PL, McDonald

GB, Striker GE, Sale GE, et al. Chronic graft-versus-host

syndrome in man: a long-term clinicopathologic study of 20

Seattle patients Am J Med 1980;69:204–17.

Ogawa Y, Kuwana M, Yamazaki K, Mashima Y, Yamada M,

Mori T, et al. Periductal area as the primary site for T-cell

activation in lacrimal gland chronic graft-versus-host disease.

Invest Ophthalmol Vis Sci 2003;44:1888–96.

Shahid J. Graft versus host disease (GVHD). J Pak Assoc

Derma 1998;8(1):2–5.

Toda I, Tsubota K. Practical double staining for ocular

surface evaluation. Cornea 1993;12:366–8.

Ban Y, Ogawa Y, Goto E, Uchino M, Terauchi N, Seki M, et

al. Tear function and lipid layer alterations in dry eye patients

with chronic graft-vs-host disease. Eye 2009;23(1):202–8.

Ogawa Y, Okamoto S, Wakui M, Watanabe R, Yamada M,

Yoshino M, et al. Dry eye after haematopoietic stem cell

transplantation Br J Ophthalmol 1999;83:1125–30.

Shimazaki J, Goto E, Ono M, Shimmura S, Tsubota K..

Meibomian gland dysfunction in patients with sjogren

syndrome. Ophthalmology 1998;105:1485–8.

Shimazaki J. Definition and criteria of dry eye. Ganka

(Japan) 1995;37:765–70.

Lemp MA. Report of the National Eye Institute workshop on

clinical trials on dry eye. CLAOJ 1995;21:221–32.

Livesey SJ, Holme JA, Whittaker JA. Ocular complication of

bone marrow transplantation. Eye 1989;3:271–6.

Fahnehjelm KT, Tornquist AL, Winiarski J. Dry-eye

syndrome after allogeneic stem-cell transplantation in

children. Acta Ophthalmol. 2008;86:253–8.

Fei WL, Chen JQ, Du X, Liu YH, Sun MX, Lin JX, et al.

Dry eye in graft-versus-host disease. Zhonghua Yan Ke Za

Zhi 2003;39:686–90.

Calissendrorff B, Azaz ME, Lonnqvist B. Dry eye syndrome

in long term follow up of bone marrow transplanted patients.

Bone Marrow Transplant 1989;4:675–8.

Mencucci, R, Ferrini, CR, Bosi, A, Volpe, R, Guidi, S, Salvi,

G. Ophthalmological aspects in allogeneic bone marrow

transplantation: Sjögren-like syndrome in graft-versus-host

disease Eur J Ophthalmol 1997;7:13–8.

Tichelli A, Duell T, Weiss M, Socié G, Ljungman P, Cohen

A, et al. Late-onset keratoconjunctivitis sicca syndrome after

bone marrow transplantation: Incidence and risk factors Bone

Marrow Transplant 1996;17:1105–11.

Bray LC, Carey PJ, Proctor SJ, Proctor SJ, Evans RG,

Hamilton PJ. Ocular complications of bone marrow

transplantation. Br J Ophthalmol 1991;75:611–4.

Hettinga YM, Verdonek LF, Finjnheer R, Rijkers

GT, Rothova A. Anterior uveitis: A manifestation of chronic

graft versus host disease. Ophthalmology 2007;114:794–7.

Arain MA, Khan MD, Niazi MK, Ahmed P. Bilateral

lacrimal bicanalicular obstruction in chronic graft versus host

disease. Pak J Pathol 2009;20:23–4.

Spraul CW, Land GE, Kang GK. Corneal ulcer in chronic

graft-versus-host disease: Treatment with collagen shields.

Klin Monatsbl Augenheilkd 1994;205:161–6.

Mohammadpour M. Progressive corneal vascularization

caused by graft-versus-host disease. Cornea. 2007;26:225–6.

Kerty E, Vigander K, Flage J, Brinch L. Ocular findings in

allogenic stem cell transplantation without total body

irradiation. Ophthalmology 1999;106:1334–8.

Alvarez MT, Hernaez JM, Ciancas E, Figueroa MS.

Multifocal choroiditis after allogenic bone marrow

transplantation. Eur J Ophthalmol 2002;12:135–7.