MGD, Keratitis Common in Graft-vs.-Host Patients

At baseline examination, patients with GVHD had MGD and/or keratitis, showing that it is difficult to treat, requires several treatments and the need for earlier diagnosis and earlier referral. Photo: Heather Spampinato, OD. Click image to enlarge. Chronic ocular graft-vs.-host disease (GVHD) is a debilitating complication of stem cell transplantation that leads to persistent ocular surface damage, visual morbidity and substantial treatment burden. Despite its prevalence, long-term outcome data remains limited, which is why researchers recently conducted a retrospective review of ocular outcomes. They found that 80% of the patients had meibomian gland dysfunction (MGD) and 50% had keratitis, requiring several treatments and showing how difficult GVHD is to treat. The findings were reported in Eye.This retrospective cohort study included 189 patients for a maximum of five years within a 12-year study period and examined predictors of poor ocular outcomes, defined by slit lamp findings such as superficial punctate keratitis (SPK), filamentary keratitis, conjunctival and corneal complications, as well as functional measures such as visual acuity and intraocular pressure.The researchers observed that ocular surface disease remained persistent and clinically significant— meaning, severe enough to require escalation of adjunctive therapies or associated with vision-threatening complications—up to five years after diagnosis. At baseline, 81.5% of patients had MGD and 49.7% had SPK. At final follow-up, more than half of patients continued to demonstrate both conditions, despite increased use of advanced therapies. This aligns with earlier reports showing structural gland dropout and chronic epithelial instability in patients with graft-vs.-host disease.  For more on GVHD, see this feature. “Mechanistically, chronic inflammation from donor T-cell infiltration and sustained cytokine production (e.g., IFN-γ, IL-1β, TNF-α) drives lacrimal gland fibrosis, goblet cell loss and progressive ocular surface breakdown,” the researchers wrote in their paper. “These inflammatory cascades also contribute to conjunctival scarring and limbal stem cell deficiency.”Higher baseline NIH Eye Scores were significantly associated with the later development of filamentary keratitis and greater treatment burden, including the use of topical cyclosporine, autologous serum tears, scleral lenses and punctal cautery.In addition, a longer interval from treatment to GVHD diagnosis was independently associated with the development of limbal stem cell deficiency, highlighting diagnostic delay as a potentially modifiable risk factor. “Notably, the distribution of overall GVHD severity (mild, moderate, severe) did not differ significantly across interval groups, suggesting that the observed association is unlikely to be explained solely by differences in baseline systemic disease severity,” the authors wrote in their paper. “These findings align with prior studies demonstrating that systemic GVHD activity, particularly in the lungs and oral mucosa, can signal more severe or persistent ocular involvement.”Over the five-year follow-up, vision-threatening complications developed in some patients, including limbal stem cell deficiency (4.8%), filamentary keratitis (3.7%) and corneal neovascularization (2.6%).Therapeutic requirements increased over time. By year five, 92.1% of patients required artificial tears, 47.1% used autologous serum tears, 28% underwent punctal cautery, 19% used scleral lenses and 7.4% used topical cyclosporine.These findings underscore the progressive, treatment-resistant nature of oGVHD and highlight the value of early ophthalmic referral and multidisciplinary management to preserve vision and quality of life.Click here for the journal source.  Gill K, Burgos-Blasco B, Verma A, et al. Long-term clinical outcomes in chronic ocular graft-versus-host disease: a retrospective cohort study. Eye. April 24, 2026. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.