Screening eyes for chronic GVHD

Evaluation

Dry, burning, gritty eyes

Itching

Orbital pain

Difficulty opening eyes in the morning

Sensitivity to light and wind

Excessive tearing

Diminished visual acuity and/or blurring

Clinical manifestation	Description
New onset dry, gritty or painful eyes*	New ocular sicca documented by low Schirmer's test values with a mean value of both eyes 5 mm of wetting at 5 minutes, but note that Schirmer's test values are not useful for follow-up of ocular GVHD due to poor correlation with symptom change
Cicatricial conjunctivitis*	Fibrous tissue scaring and inflammation
Keratoconjunctivitis sicca (KCS)*	Inflammation of cornea and conjunctivae, with dryness, grittiness and/or orbital pain. Slit lamp exam with mean Schirmer's test values of 6 to 10 mm, not due to other causes
Confluent areas of punctate keratopathy*	Closely spaced, non-inflamed pinpoint defects indicating loss of corneal epithelium, and observed with fluorescein staining
Photophobia**	Increased sensitivity to light
Periorbital hyperpigmentation**	Excess pigmentation in the tissues surrounding or lining the orbit of the eye
Blepharitis**	Erythema and edema of the eyelids and telangiectasia of lid margin

* Distinctive but insufficient alone to establish an unequivocal diagnosis of chronic GVHD without further testing or additional organ involvement.

** Rare, controversial, or non-specific features of chronic GVHD.

*** Common in both acute and chronic GVHD.

This photo atlas contains pictorial representations of various clinical manifestations of chronic GVHD.

Keratoconjunctivitis sicca
Inadequate tear production (measured by Schirmer's test) and conjunctival erythema. Also note scleral injection and chemosis (conjunctival edema).
Keratoconjunctivitis sicca
Note scleral injection and conjunctival erythema.
Blepharitis
Thickened, edematous and erythematous eyelid margins. Also note plugging of meibomian gland orifices (along the eyelid margin) and significant conjunctival hyperemia/injection.