Treating Graft Versus Host Disease Using Scleral Lenses

Scleral Lenses for the Treatment of Graft vs Host Disease

Over the years, scleral lenses have emerged as a valuable tool in managing a wide range of ocular complications associated with Graft-versus-host disease (GVHD). GVHD can affect various organs, including the eyes, causing discomfort, vision problems, and potential damage. However, scleral lenses offer unique advantages for GVHD patients, providing a protective and therapeutic solution. These specialized lenses vault over the cornea and rest on the sclera, creating a reservoir of fluid that helps alleviate dryness, protect the ocular surface, and improve visual acuity. By offering a range of benefits such as enhanced comfort, improved vision, and protection for fragile ocular surfaces, scleral lenses have become a promising option in the comprehensive care of GVHD-related ocular complications.

What is Graft vs Host Disease?

Graft-versus-host disease (GVHD) is a medical condition that can occur after a stem cell or bone marrow transplant. It arises when the transplanted cells (the graft) recognize the recipient’s body tissues (the host) as foreign and launch an immune response against them. During a transplant, healthy stem cells or bone marrow from a donor are infused into a patient’s body to replace damaged or diseased cells.

How Can GVHD Impact the Eyes?

When GVHD affects the eyes, it is known as ocular GVHD. The condition primarily targets the ocular surface, which includes the cornea, conjunctiva, and lacrimal glands. The severity and specific symptoms can vary among individuals, but some common ocular manifestations of GVHD include:

  1. Dry eyes: Ocular GVHD frequently leads to reduced tear production or altered tear composition, resulting in dryness of the eyes. This can cause discomfort, irritation, redness, and a feeling of grittiness or foreign body sensation in the eyes.
  2. Conjunctivitis: Inflammation of the conjunctiva, the thin membrane that covers the whites of the eyes and the inner surface of the eyelids, can occur in ocular GVHD. Conjunctivitis can cause redness, swelling, discharge, and discomfort.
  3. Corneal damage: GVHD can affect the cornea, the clear front part of the eye. Corneal damage can manifest as epithelial defects, corneal erosions, or even corneal ulcers. These conditions may result in blurred vision, pain, sensitivity to light (photophobia), and increased risk of corneal infections, and scarring if not treated.
  4. Meibomian gland dysfunction: The meibomian glands are responsible for producing the oily component of tears, which helps prevent tear evaporation. Ocular GVHD can lead to dysfunction of these glands, resulting in meibomian gland dysfunction (MGD). MGD can further contribute to dryness and discomfort in the eyes from excessive evaporation of the tears.
  5. Symblepharon: In severe cases of ocular GVHD, adhesions may form between the conjunctiva and the cornea or between the conjunctiva and the eyelids. These adhesions are known as symblepharon and can restrict the movement of the eyelids and lead to further complications.

Management of ocular GVHD typically involves a multidisciplinary approach. Treatment may involve artificial tears, lubricating ointments, anti-inflammatory medications, immunosuppressive drugs, and in some cases, surgical interventions to manage complications like symblepharon.

What are the Benefits of Scleral Lenses for Graft vs Host Disease?

Scleral lenses offer several benefits for individuals with Graft-versus-host disease (GVHD) who experience ocular complications. Some of the key advantages include:

  1. Protection and Lubrication: Scleral lenses create a protective barrier of fluid between the lens and the cornea. This reservoir acts as a barrier, shielding the sensitive corneal surface from environmental factors, reducing friction, and providing constant lubrication. This feature is particularly beneficial for individuals with severe dryness and corneal damage caused by GVHD.
  2. Enhanced Comfort: The large diameter of scleral lenses allows them to rest on the sclera, the white part of the eye. As a result, they distribute their weight evenly, reducing pressure on the cornea. This design minimizes discomfort associated with corneal sensitivity, corneal erosions, or exposure keratitis, which are common in GVHD-related ocular complications.
  3. Improved Visual Acuity: GVHD can cause irregularities in the cornea, leading to distorted vision. Scleral lenses create a smooth, uniform optical surface, compensating for corneal irregularities and providing better visual acuity. These lenses correct refractive errors and astigmatism, helping GVHD patients achieve clearer and more stable vision.
  4. Long-lasting Moisture: Scleral lenses’ fluid reservoir acts as a constant source of moisture, preventing rapid tear evaporation and maintaining a stable tear film. This feature is especially beneficial for individuals with severe dry eye symptoms resulting from GVHD. By keeping the ocular surface consistently hydrated, scleral lenses alleviate dryness, reduce inflammation, and promote healing.
  5. Protection against Inflammation: GVHD-related inflammation in the eyes can lead to conjunctivitis, keratitis, and other complications. Scleral lenses shield the cornea from exposure to irritants, allergens, and pathogens present in the environment. By creating a physical barrier, these lenses can minimize the risk of further inflammation and infection, helping to manage ocular symptoms.

Scleral Lenses Can Help to Treat Graft vs. Host Disease

With the expertise of eye care professionals at WCLI, scleral lenses can significantly improve the quality of life for GVHD patients, allowing them to experience greater comfort, clearer vision, and enhanced ocular health. As research and advancements continue, scleral lenses offer promising possibilities in the comprehensive care and management of GVHD-related ocular complications. Get in touch with us today to learn more!

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