What is GVHD of the eyes (ocular GVHD)?

Chronic graft-versus-host disease (GVHD) of the eyes happens when the donated cells a patient receives during a blood or marrow transplant (BMT) begin attacking the eye conjunctiva and glands. The conjunctiva is the tissue that covers the white part of your eye and the inside of your eyelids. Eye glands make tears that help your eyes stay moist and smooth.

• Dry, gritty or burning sensation in the eyes
• Red or inflamed eyes
• Blurry vision that improves with lubrication
• Sensitivity to light
• Discomfort when in wind, air conditioning or dry environments
• Pain when blinking or keeping eyes open

• Difficulty keeping eyes open due to irritation
• Scarring of the conjunctiva in advanced cases
• Incomplete eyelid closure during sleep

To learn more about how GVHD can affect different parts of your body, view our full list of GVHD symptoms.

• Use preservative-free artificial tears throughout the day to keep eyes moist.
• Apply lubricating eye gel or ointment at night, especially if your eyes don’t close fully during sleep.
• Avoid windy or dry environments, such as air-conditioned rooms.
• Take 1–2 tablespoons of flaxseed oil daily (mixed into food or juice).
• Wear wraparound glasses or moisture goggles outdoors to reduce dryness.

• Let your doctor know if your dry eyes worsen, or if pain or redness increases.
• Watch for changes in your vision. This may signal more severe dryness or damage.
• Monitor for signs of infection, like increased discharge or swelling.

• Your eyes become more dry or painful.
• Your vision changes or becomes blurry.
• Your eyes become red, swollen or hard to open.
• You feel sharp pain or discomfort that doesn’t go away.

• See an ophthalmologist (eye doctor) or optometrist who has experience treating BMT patients.
• Tell your care team about any vision-related changes or discomfort—even if mild.
• Ask your doctor or pharmacist if any of your medications could be making your dry eye symptoms worse (e.g., antihistamines, sleep aids, antidepressants).

Your doctor or eye specialist can usually diagnose ocular GVHD during an eye exam. In some cases, special eye tests or imaging may be used to check tear production or detect surface damage.

If GVHD of the eyes is found, treatment may include:

• Prescription eye drops with immunosuppressants, such as cyclosporine or steroid drops.
• Prescription pills like cevimeline or pilocarpine to help your body make more tears.
• Punctal plugs to block tear drainage and keep your natural tears on your eyes longer.
• Autologous serum eye drops made from your own blood to support healing.
• Bandage contact lenses or PROSE lenses to protect your eyes from dryness and friction.