Tear function and lipid layer alterations in dry eye patients with chronic graft-vs-host disease

Purpose To investigate the changes in the tear film lipid layer in haematopoietic stem cell transplantation (HSCT) patients with dry eye ( DE) associated with chronic graft-vs-host disease (cGVHD) and compare with HSCT recipients without DE. Methods We performed a prospective study in 10 HSCT patients with DE associated with cGVHD and 11 HSCT recipients without DE. We performed Schirmer's test, tear film break up time examinations, ocular surface dye staining and meibum expressibility test and DR-1 tear film lipid layer interferometry. DR-1 interferometry images of the tear film surface were assigned a 'DR-1 grade' according to the Yokoi severity grading system. The DR-1 grades were analysed according to the presence or absence of DE, conjunctival fibrosis and systemic cGVHD. Results The mean DR-1 severity grade in patients with DE related to cGVHD (DE/cGVHD group; 3.9 +/- 0.9) was significantly higher than in patients without DE after HSCT (non-DE/non-cGVHD group; 1.3 +/- 0.6; P < 0.05). The DR-1 grade for HSCT recipients with conjunctival fibrosis was significantly higher than in patients without conjunctival fibrosis (P < 0.05). When DE severity was graded according to the recommendation of the 2007 Dry Eye Workshop Report, our results showed a correlation between the severity of DE and DR-1 grades (r = 0.8812, P < 0.0001). Conclusion DR-1 interferometry may be applicable to diagnosing DE and evaluating its progression subsequent to HSCT.