One of the many side effects of a stem cell transplant is Dry Eye Syndrome. I had dry eyes before my transplant due to lasik surgery. However, in the past few months the condition has gone from a mere inconvenience to a real problem. I have been using Refresh eye drops several dozen times a day which is extreme. I noticed that all the photos of me in the past month or two show me squinting to the point that my eyes look like they are always shut. Pain in my right eye became so severe, I visited Dr. G, my opthamologist, last week. Dr. G found filamentary keratitis attached to my right cornea which was causing me severe pain. A filamentary keratitis is a collection of dead epitheal cells and mucus that forms a blob and attaches to the surface of the cornea. Dr. G “debrided” or removed it from my cornea using surgical forceps that resemble large tweezers. Here’s a video showing how a filamentary keratitis is removed. Dr. G also prescribed steroid drops (Methylprednisolone) for my right eye.
Yesterday I saw Dr. T at MD Anderson Cancer Center. She specializes in eye problems caused by GvHD. She explained to me that dry eye syndrome is often caused by the stem cell transplant itself and that, in some cases, it is made much worse by GvHD. Her job was to determine whether my problems were just plain dry eye or a symptom of GvHD of the eyes. She conducted a Schirmer test on me which is the insertion of paper strips under the eyelids to tell how much moisture is present. A Schirmer score of less than 10 indicates dry eye syndrome. My right eye had a score of 2 and my left scored a 4. Her intern recommended punctal plugs and inserted one in each eye. A punctal plug is a piece of silicone that is inserted in the tear duct to prevent tears from draining away from the eye. Here’s a video showing the insertion of punctal plugs. Punctal plugs don’t eliminate the need for artificial tears but should improve the dry eye condition.
Dr. T did not see the scar tissue under my eyelids that is usually present when GvHD attacks the eyes. In other words, my stem cell transplant has caused a severe dry eye condition but it is not due to my brother’s T-cells attacking my eyes. That’s really good news.