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Br J Ophthalmol 1999;83:1125-1130 ( October )

Dry eye after haematopoietic stem cell transplantation

Yoko Ogawaa, Shinichiro Okamotob, Masatoshi Wakuib, Reiko Watanabeb, Masakazu Yamadaa, Mami Yoshinoa, Masafumi Onoa, Hao-Yung Yanga, Yukihiko Mashimaa, Yoshihisa Oguchia, Yasuo Ikedab, Kazuo Tsubotac

a Department of Ophthalmology, Keio University, School of Medicine, Tokyo, Japan, b Keio BMT Program, Division of Haematology, Department of Medicine, Keio University, School of Medicine, Tokyo, Japan, c Department of Ophthalmology, Tokyo Dental College, Chiba, Japan

Correspondence to: Kazuo Tsubota, MD, Department of Ophthalmology, Tokyo Dental College, 5-11-13, Sugano, Ichikawa City, Chiba, 272-8513, Japan.

Accepted for publication 28 June 1999

AIMS---To determine the incidence, natural course, and severity of dry eye occurring or worsening after haematopoietic stem cell transplantation (SCT).
METHODS---At a tertiary care hospital, 53 patients undergoing allogeneic or autologous SCT followed by at least 180 days of follow up were studied prospectively. Examination included grading of symptoms of dry eye, evaluation of ocular surface, tear break up time, and Schirmer tests with and without nasal stimulation. Meibomian gland secretion was also examined using a slit lamp while applying steady digital pressure.
RESULTS---Of the 53 patients, 44 received allografts. Half of these patients (22) developed dry eye or their pre-existing dry eye worsened after SCT, while none of nine autograft recipients did. Onset of dry eye was 171 (SD 59) days after SCT. Two types of dry eye occurred. One (n=10) was severe with ocular surface findings resembling Sjögren's syndrome and reduction of reflex tearing soon after onset. A mild type (n=12) had unimpaired reflex tearing. Meibomian gland dysfunction (MGD) was more frequent and severe in patients with dry eye and chronic graft versus host disease (GVHD), and overall severity of dry eye was greater in patients with MGD and chronic GVHD.
CONCLUSIONS---Dry eye after SCT occurred only in allograft recipients, and was not evident in autograft recipients. The severe form of dry eye had a tendency to develop rapidly. Further study on the prediction and treatment of severe dry eye after SCT is necessary.

© 1999 by British Journal of Ophthalmology


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