Non infectious ocular surface inflammation: Paediatric GVHD

Abstract

Although ocular findings and treatment for GVHD are described in adult patients, the literature describing this condition in paediatric patients is relatively few. In children, detection of symptoms and diagnosis of ophthalmic findings are more difficult than in adults, as history taking, clinical examination and diagnostic tests such as fluorescein staining or Schirmer tests are difficult to perform due to limited cooperation. Also patients cannot specify their complaints and symptoms especially in younger age group. Follow‐up and frequent ophthalmic evaluation are important in diagnosis and management of children who had bone marrow transplantation. Even though ophthalmic findings are common in children, usually milder than adults but timely diagnosis and management are very important to decrease secondary eye complications such as corneal ulcers and vision loss and also to improve quality of life.Graft‐versus‐host disease (GVHD) is a major complication of bone marrow transplantation that is performed for haematological malignancies and diseases and seen in 50–70% of cases. It is a complex clinical disease with many organ and system involvement. Acute form is seen in the first 3 months after transplantation, systemic manifestation mainly include hepatitis and skin involvement and chronic form is mostly seen after acute GVHD. Ocular manifestations can be classified as acute and chronic and also as anterior and posterior. Most common ocular finding is dry eye with corneal involvement and seen in 40–90% of patients with chronic GVHD. Corneal vascularization, keratitis and even perforation can be seen. Conservative treatment with topical steroids, autologous serum, lubricant eye drops and ointments should be integrated with topical cyclosporine‐A that might be an effective and safe treatment option in dry eye related to chronic GVHD.