What is GVHD of the eyes (ocular GVHD)?

Chronic GVHD (graft-versus-host-disease) of the eye happens when the donor’s cells attack 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.

Here’s how this disease progresses:

• First, the conjunctiva and tear glands get inflamed (red and swollen). Then the glands stop making enough tears. When this happens you may feel some grittiness, discomfort or pain.
• Later the conjunctiva and glands become scarred and damaged. When this happens your eye glands can’t make the tears that keep your eyes moist and smooth. Your eyes may become very irritated and painful.

Here’s how you can reduce symptoms of chronic GVHD of the eye:

• Keep your eyes moist to reduce your eye dryness as much as possible and to stop damage to your eyes.
• Stay out of wind, air conditioning and dry environments.
• To keep your eyes moist and use artificial tears. You can buy artificial tears from a drug store or pharmacy without a prescription. Use the ones that are preservative free. Preservatives can irritate your eyes. There are many brands of artificial tears. People often try several before finding one that works for them.
• To keep your eyes moist while you sleep, use eye gel or ointment at night. This is especially important if you don’t close your eyes completely when you sleep.
• Take flaxseed oil. Mix 2 tablespoons with your juice or food every day.

• Prescription eye drops that have immunosuppressant medicines (medicines that hold back your immune system) may help. Examples include cyclosporine or steroids.
• Prescription pills that help your body make more tears may help. Examples include cevimeline or pilocarpine.
• Punctal plugs are placed to block the tiny tubes that drain your tears from your eyes. This makes your tears last longer. Punctal plugs can be temporary or permanent.
• Ask your doctor or pharmacist if any of your other medicines could be making your dry eyes worse. Some medicines, like pain medicine, antihistamines, antidepressants and sleeping pills, may cause dry eyes.
• Autologous serum eye drops are special eye drops made just for you by a pharmacy. The liquid from a tube of your blood is put into vials for you to put in your eyes like eye drops. The liquid part of your blood contains a lot of proteins that help tissues heal.
• Bandage contact lenses or PROSE lenses are special protective contact lenses that protect the eye from damage caused by dryness. Ask your eye doctor (ophthalmologist or optometrist) or transplant doctor if these could be an option for you.

While severe dry eye is often permanent, symptoms of mild chronic GVHD of the eye may get better with treatment.

• Vision is usually not affected unless the surface of the eye is very damaged.
• Sometimes eyesight is blurry because of dry eyes and irritation. This improves if the eye is lubricated.
• Chronic GVHD does not affect the inner eye structures or the nerves responsible for vision.

• Your eyes get more dry
• Your eyes hurt
• Your vision changes