Ocular GVHD and Dry Eye Disease: Differentiating the Overlap

Ocular graft-versus-host disease (oGVHD) mimics dry eye disease (DED) like Sjögren’s syndrome or meibomian gland dysfunction (MGD), complicating diagnosis. This post dissects their overlap and distinctions, leveraging clinical and molecular insights.

Shared Features
Both oGVHD and DED present with dryness, photophobia, and tear film instability. Schirmer’s scores <5 mm and corneal staining occur across conditions. A 2024 Ocular Surface study found 70% symptom overlap, with OSDI scores indistinguishable in mild cases.

Distinct Pathophysiology
oGVHD’s alloimmune basis—donor T-cell infiltration—contrasts with Sjögren’s autoimmunity (anti-Ro/La antibodies) or MGD’s lipid dysfunction. Tear IL-6 exceeds 50 pg/mL in oGVHD but not primary DED, per 2025 Cornea data. Conjunctival scarring, rare in DED, marks oGVHD progression.

Diagnostic Differentiation
IVCM shows corneal nerve loss in oGVHD, unlike Sjögren’s subbasal preservation. Meibography highlights gland dropout in both, but oGVHD adds pseudomembranes. Serology (e.g., ANA positivity in Sjögren’s) and transplant history refine the picture.

Therapeutic Divergence
Topical cyclosporine benefits both, but oGVHD often requires systemic immunosuppression. ASEDs aid severe cases universally, while Sjögren’s may need salivary stimulants. Misdiagnosis risks undertreatment in oGVHD, accelerating vision loss.

References

1. Craig, J. P., Nichols, K. K., Akpek, E. K., et al. (2017). TFOS DEWS II definition and classification report. Ocular Surface, 15(3), 276-283.
2. Shikari, H., Antin, J. H., & Dana, R. (2013). Ocular graft-versus-host disease: A review. Survey of Ophthalmology, 58(3), 233-251.
3. Ogawa, Y., Kim, S. K., Dana, R., et al. (2013). International Chronic Ocular Graft-vs-Host-Disease (GVHD) Consensus Group: Proposed diagnostic criteria for chronic GVHD (Part I). Scientific Reports, 3, 3419.
4. Stern, M. E., Schaumburg, C. S., & Pflugfelder, S. C. (2013). Dry eye as a mucosal autoimmune disease. International Reviews of Immunology, 32(1), 19-41.
5. Riemens, A., te Boome, L., Imhof, S., et al. (2010). Current insights into ocular graft-versus-host disease. Current Opinion in Ophthalmology, 21(6), 485-494.