Dry eye as a major complication associated with chronic graft-versus-host disease after hematopoietic stem cell transplantation

Purpose: To review the condition of dry eye associated with chronic graft-versus-host disease (GVHD). Methods: The immunopathogenic processes and therapeutic options for lacrimal gland chronic GVHD are discussed. Results: Dry eye is the most frequent ocular complication after hematopoietic stem cell transplantation. The condition typically occurs around 6 months post-operation and is recognized as a complication of chronic GVHD. Lacrimal gland specimens from patients with dry eye show prominent fibrosis and an increase in CD34(+) stromal fibroblasts in the glandular interstitium in addition to infiltration of T cells into the periductal areas. in periductal areas, CD4(+) and CD8(+) T cells colocalize with stromal fibroblasts that express the full component of surface molecules necessary for antigen presentation. These findings strongly suggest that periductal fibroblasts are involved in fibrogenic and immune processes by interacting with T cells in the lacrimal gland of patients with chronic GVHD, resulting in rapidly progressive dry eye. Current therapies for dry eye related to chronic GVHD include tear supplements and nonspecific immunosuppressants. Conclusion: We report a significant role for stromal fibroblasts in the pathogenic processes of dry eye related to chronic GVHD. Although several supportive therapies can reduce the symptoms, specific therapies that suppress fibrotic and immune processes in the lacrimal glands are necessary to control dry eye associated with chronic GVHD.