Dry Eyes in Graft-Versus-Host Disease: A Clinical and Immunohistochemical Study of Lacrimal Gland and Conjunctival Tissue in Patients Undergoing Bone Marrow Transplantation

Abstract

Abstract: : Purpose: To evaluate the frequency of dry eye syndrome in patients with graft-versus-host disease and to identify the cellular phenotype of the conjunctival and lacrimal gland inflammatory infiltrate in these patients. Methods: Dry eye evaluation was performed by clinical examination, Schirmer testing, tear break-up time and Rose Bengal staining in patients undergoing autologous and allogenic bone marrow transplantation. Conjunctival and lacrimal gland biopsies were performed prior to and following transplantation. Monoclonal antibodies and an immunoperoxidase technique were employed to characterize the inflammatory infiltrate within these tissues. Results: Forty-seven patients, 13 of whom received autologous bone marrow and 34 of whom received allogenic bone marrow grafts, were studied. Eighty-two percent of patients receiving allogenic bone marrow grafts developed chronic graft-versus-host disease, and of these, 41% developed dry eye syndrome. No patient receiving autologous bone marrow developed graft-versus-host disease or dry eye syndrome. A predominantly CD4 positive lymphocytic infiltrate was found in the conjunctiva and lacrimal glands of patients with dry eye syndrome secondary to graft- versus-host disease. Conclusions: Our results suggest that dry eye syndrome secondary to graft-versus-host disease in allogenic bone marrow transplant patients may be mediated by a predominantly CD4 positive T- lymphocytic infiltrate within the lacrimal glands and conjunctiva.

Keywords: cornea: tears/tear film/dry eye • lacrimal gland • conjunctiva