Bilateral corneal ulceration in ocular graft-versus-host disease
A 39-year-old man presented complaining of blurred vision and photophobia. The patient’s past medical history was significant for NHL treated with allogeneic HSCT that resulted in ocular GVHD, and an episode of stromal thinning. The patient presented complaining of blurred vision without any associated pain. Ocular examination revealed a 2 mm2 area of stromal thinning in the patient’s right (first) eye. Lubricating eye drops and cyclosporine (Restasis®; Allergan, Irvine, CA, USA) were increased, prophylactic antibiotics were initiated, and a therapeutic contact lens was placed. Shortly after this visit, the patient was admitted to Massachusetts General Hospital for systemic manifestations of chronic GVHD. At the time of admittance, the patient complained of severe pain, decreased visual acuity, and photophobia. Ocular examination revealed a 3.6 × 4.4 mm inferocentral area of stromal thinning in the patient’s right (first) eye. The corneal thinning continued to increase in the patient’s right (first) eye, and a central epithelial defect began to form in his left (second) eye. The epithelial defect in the left (second) eye rapidly progressed to stromal melting, necessitating treatment with a scleral lens. Following placement of the scleral lens, the patient reported increased comfort and his BCVA improved to 20/80 in his left eye; however, he died several days later from complications of systemic GVHD.