Ocular surface and lacrimal disturbances in chronic graft-versus-host disease: the role of conjunctival biopsy.

Forty-four patients (21 male, 23 female) were studied following bone marrow transplantation (BMT): 40 after allogeneic, one after syngeneic and three after autologous transplantation. Diffuse punctate conjunctival and corneal epitheliopathy was seen in 27 (61%), reduced or disordered tear film in 26 (59%), acquired lacrimal outflow obstruction in three (7%) and posterior subcapsular lens opacities in five (12%) patients. Conjunctival histology showed abnormal features, including those of graft-versus-host disease (GVHD) in 41 patients. Of these, 28 (64%) had clinical and laboratory features of GVHD and six patients with no systemic evidence of GVHD had conjunctival histology specific for GVHD. We conclude that after BMT, subclinical changes of GVHD are very common in the periocular tissues and may be universal in long-term survivors following allogeneic BMT. Some minor conjunctival changes are more likely to be due to the primary disease or the transplant conditioning regimen. Conjunctival biopsy is useful in demonstrating low-grade GVHD or GVHD confined to the ocular structures and may be diagnostic in some cases.