Sjögren-like syndrome after bone marrow transplantation.
OBJECTIVE
To study the incidence of dry eye in Sjögren-like syndrome, graft-versus-host disease (GVHD) in hematological patients undergoing bone marrow transplantation (BMT).


METHODS
Prospective, cross-sectional study in twenty-six patients that were planned for BMT (group I). Twenty-nine patients undergoing BMT before study were classified as group II no GVHD (9), and group III with GVHD (20). Thirty-two normal subjects were controls. All subjects were examined by slit lamp biomicroscopy and had their tear samples analyzed about tear osmolarity. They were also evaluated for aqueous tear production by phenol red thread test, Schirmer test without anesthesia, tear film stability by tear break-up time (TBUT), and rose bengal staining 2 weeks before BMT (for group I) as well as 6 weeks, 3 months, and 6 months after BMT. The patients with GVHD were followed up 1 month later. Main outcome measures were amount of tear production, tear film stability, and dry eye symptoms.


RESULTS
Average aqueous tear production in group III was less than control and group II (p < 0.001). Mean TBUT in group III was faster than control (p < 0.001) and group I before BMT (p = 0.001). Mean score of rose bengal staining in group III was more than control and group I before BMT (p < 0.001). Keratoconjunctivitis sicca and red eye developed in 27.5%, and 20% of group III, with incidence of dry eye by Schirmer test without anesthesia (67.5%). This compares with group II having incidence of dry eye of 16.7%. However, 42.3% of group I before BMT had dry eye compared with 9.4% in the controls (p < 0.001).


CONCLUSIONS
Trend of dry eye in patients with BMT and GVHD were higher than no-GVHD group. Doctors should be aware of ocular symptoms and signs of dry eye in patients with BMT and follow-up for proper management.
Kosrirukvongs
Panida
P
Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. sipks@mahidol.ac.th
Chirapapaisan
Niphon
N
Visuthisakchai
Sanan
S
Issaragrisil
Surapol
S
Gonggetyai
Vanngarm
V
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D016022:Case-Control Studies; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D007637:Keratoconjunctivitis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010637:Phenolsulfonphthalein; D011446:Prospective Studies; D012307:Risk Factors; D012859:Sjogren's Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D055815:Young Adult
D010637:Phenolsulfonphthalein