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Ocular Graft Versus Host Disease: Just a Severe Form of Dry Eye or Something More?

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Abstract

Purpose of Review

To discuss the current understanding of ocular graft versus host disease (oGVHD) pathophysiology, its associated diagnostic guidelines, and treatment modalities.

Recent Findings

oGVHD results from a myriad of inflammatory processes that damages the ocular surface by directly destroying the corneal surface, lacrimal glands, meibomian glands, and the corneal nerves. As a result, signs and symptoms of oGVHD can be similar to that of aqueous deficient or evaporative dry eye disease. There are various consensus criteria that have been created and validated; however, the lack of clear universal guidelines and objective biomarkers can make diagnosis of oGVHD a challenge.

Summary

GVHD is caused by an attack from the donor immune cells to the recipient through complex dysregulated inflammatory processes that damage various organs, including the ocular surface, resulting in ocular GVHD, an inflammatory dry eye with corneal nerve and adnexal injury. The hallmark of treatment is an aggressive anti-inflammatory regimen, combined with supplementary lubrication, lid hygiene, and scleral lens devices. Future research should be aimed at identifying clinical tests that detect and quantitate inflammation on the ocular surface, as well as novel treatment regimens that can directly target the pathways of inflammation on the ocular surface more effectively.

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Authors and Affiliations

  1. Foster Center for Ocular Immunology, Duke Eye Center, Duke University, Durham, NC, 27710, USA

    Sofia E. Murillo, Matias Soifer & Victor L. Perez

  2. Department of Ophthalmology, Duke University Medical Center, Durham, NC, 27705, USA

    Sofia E. Murillo, Matias Soifer & Victor L. Perez

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  1. Sofia E. Murillo
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Correspondence to Victor L. Perez.

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S.E.M: none, M.S: none, V.L.P: National Institutes of Health/National Eye Institute: R01EY030283 (Dr. Perez), R01EY024485 (Dr. Perez), Duke NIH Center Core Grant: EY005722 (Dr. Perez), and Duke Research to Prevent Blindness Unrestricted Grant (Dr. Perez), Alcon, Eyegate, Kala, Novartis, Trefoil, Quidel.

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Murillo, S.E., Soifer, M. & Perez, V.L. Ocular Graft Versus Host Disease: Just a Severe Form of Dry Eye or Something More?. Curr Ophthalmol Rep 10, 53–61 (2022). https://doi.org/10.1007/s40135-022-00281-9

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