Sjögren-Like Syndrome after Bone Marrow Transplantation
Panida Kosrirukvongs MD*, Niphon Chirapapaisan MD*, Sanan Visuthisakchai MD**, Surapol Issaragrisil MD**, Vanngarm Gonggetyai MD***
Affiliation : * Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok ** Department of Medicine, Division of Hematology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok *** Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
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).
Material and Method: 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).
Conclusion : 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.
Keywords : Sj(cid:31)gren-like syndrome, Keratoconjunctivitis sicca, graft-versus-host disease, Bone marrow trans- plantation
