Keratoconjunctivitis Sicca in Graft-Versus-Host Disease

Rose bengal staining of the conjunctiva and cornea in a patient with KCS.
  • Common after bone marrow transplantation.
  • Some ocular manifestation such as keratoconjunctivitis sicca (KCS), sterile conjunctivitis, cicatricial lagophthalmos, cataracts and retinal microvascular occlusive disease have commonly observed in patients with GVHD.
  • KCS is the most significant ocular complication associated with acute and chronic GVHD.

Clinical Features

  • Symptoms:
    • Foreign body sensation, itching, burning, and moderate conjunctival redness
    • Decreased vision, pain, and photophobia usually occur in advanced cases
    • Exacerbated by wind, blinking, or prolonged reading.
  • Signs:
    • Minimal or absent tear meniscus
    • Mucus threads and conjunctival hyperemia
    • Fine, medium or coarse epithelial keratitis
    • Filamentary keratitis may be found especially in the interpalperal fissure
    • Epithelial erosion, subsequent stromal ulceration and recurrent corneal infections may occur in more severe cases.
  • Complications include corneal scarring, neovascularization, or conjunctivalization of the cornea.


  • Vigorous surface lubrication with artificial non-preservativeartificial tears or ointment.
  • Treatment of associated systemic diseases.
  • Punctal occlusion.
  • Humidifiers or moisture chambers to decrease tear film evaporation.
  • Surgical tarsorraphy for intractable dry eye.