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Ask The Doctor
My eyes have been very dry since my bone marrow transplant.
What can I do to relieve the problem?
Mary E. D. Flowers, MD, of the Fred Hutchinson Cancer Research
Center's Long Term Follow Up Program, responds:
Dry eyes (ocular sicca) is one manifestation of graft versus host
disease (GVHD). Symptoms include burning, irritation, pain, foreign body
sensation, blurring of vision, photophobia, and excessive tearing. This problem
is often seen in patients with GVHD involving other organs, although
occasionally it may be the only symptom of GVHD or may be due to other causes.
Patients with dry eye symptoms should be seen and followed by an
ophthalmologist for periodic complete eye exams including the Schirmer to
determine tear production, and slit lamp exam to rule out corneal
abrasions.
Once diagnosed, artificial tears and ointments are recommended for
comfort and protection of the corneas and to preserve vision and prevent
permanent blindness. Several artificial tears and ointments are available. Use
of viscous eye drops such as Celluvisc can reduce the frequency of drops.
Lacriserts are small ophthalmic inserts that slowly dissolve in the eye and
have been beneficial to some patients who require frequent lubrication. Punctal
ligation (closure of tear draining ducts) is indicated for severe dry eyes.
Punctal ligation usually results in immediate relief of symptoms by preventing
available moisture from draining into the tear ducts. However, if tear
production is very low, drops may still be needed.
In cases of mild dry eyes, symptoms may improve with oral
immunosuppression given for GVHD involving other organs. However, severe dry
eyes are often irreversible and punctal ligation (rather than temporary plugs)
is indicated along with adequate lubrication of the eyes for life. Soft contact
lenses can result in symptomatic relief in some individuals. It is important to
avoid low humidity areas and wind and to carry eye drops and sunglasses at all
times. |
