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A. M. Cornelison, H. Diwan, D. R. Couriel, A. M. Alousi, S. K. Kim; Bloody Epiphora in Patients With Chronic Ocular Graft versus Host Disease; A Case Series. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2615.
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To describe bloody epiphora in patients with chronic ocular Graft versus Host disease (GVHD).
An IRB approved retrospective chart review of 4 patients with bloody epiphora in the setting of chronic ocular GVHD was conducted. Eligible patients included those that were treated at MD Anderson Cancer Center Ophthalmology clinic between 1997 and 2008. Clinical history, including their primary malignancies, stem cell transplantation histories, systemic and ocular GVHD status, and pathology reports were summarized. A comprehensive literature search for reports of bloody epiphora and its association with chronic ocular GHVD was completed.
Four patients were identified for the study, 3 males and 1 female, with a mean age of 36 years, ranging from 28-45. All patients had a history of chronic systemic GVHD treated with various drug regimens that included tacrolimus and systemic steroids. All patients had been diagnosed with chronic ocular GVHD according to the NIH chronic GVHD criteria. In 2 patients, the source of the bloody epiphora was determined to be a pyogenic granuloma arising from the punctum, while the other 2 patients had granulomatous growths on the palpebral conjunctiva of the upper lid. Excision was required in 2 cases, confirming the diagnosis, and all 4 cases responded well to topical steroid and antibiotic. One patient also had bilateral giant papillary conjunctivitis due to contact lens use in the setting of ocular GVHD, and was treated with the discontinuation of her contact lenses in combination with topical steroid. Recurrence was noted in 2 patients, 1 of which recurred after initial excision, requiring re-excision in the MD Anderson Ophthalmology clinic 3 months later. The other recurrence was noted in the patient with giant papillary conjunctivitis after returning to soft contact lens use, and was re-treated with discontinuation of contact lenses and initiation of a topical steroid taper. To date, there are no reported cases of bloody epiphora associated with granulomatous growth in chronic ocular GVHD.
This is the first case series describing bloody epiphora in chronic ocular GVHD patients. Granulomatous growths in the punctum or palpebral conjunctiva may bleed, resulting in the clinical manifestation of bloody epiphora, which can be successfully treated with topical steroid.
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