Risk Factors for Dry Eye After Hematopoietic Stem Cell Transplantation

Design: Case control analytic study

Objectives: To investigate risk factors for developing dry eye in adult patients after hematopoietic stem cell transplantation (HSCT). Secondarily, to assess severity of dry eye and tear profiles in these patients.

Methods: This study was conducted from May 2011-June 2012. Seventy-eight adult patients who underwent HSCT for various hematologic disorders at King Chulalongkorn Memorial Hospital were enrolled in this study. Two patients were excluded due to underlying lid abnormalities that might cause dry eye. Dry eye was diagnosed using standardized questionnaire, tear break-up time, Schirmer test and fluorescein and rose bengal staining. Of 76 patients, 40 patients (52.6%) had dry eye and they served as the case group. Thirty-six patients who did not meet the criteria served as the control group. Patient’s charts were reviewed for clinical data, HSCT details and complications. The main outcome measures were dry eye occurrence, severity and tear profiles.

Results: 24 of 48 patients (50%) who received allografts and 16 of 28 patients (57.1%) who received autografts had dry eye after HSCT. Peripheral blood was used as stem cell source in 96% of the patients. Dry eye manifestation was found to be positively correlated with age over 35 years, duration of systemic cyclosporine use and chronic graft-versus-host disease (GVHD) of the oral cavity (P=0.049, P=0.010 and 0.002 respectively, by univariate analysis). Using binary logistic regression, we found only chronic oral GVHD to be strongly associated with dry eye occurrence (P=0.006, odds ratio= 9.15, 95% CI 1.91-43.87). Fluorescein and rose bengal staining were classified in significantly higher grading in allogeneic than the autologous group (P<0.001 and P= 0.007 respectively, Mann-Whitney Test). Of 18 patients who had severe dry eye, 13 (72.2%) were in allogeneic and 5 (27.8%) were in autologous group.

Conclusion: Dry eye is a very common ocular manifestation after autologous and allogeneic HSCT, albeit more severe in allogeneic HSCT. In allogeneic transplant patients, close attention to the development of chronic oral GVHD may lead to early diagnosis of dry eye in these patients.