Meibomian gland dysfunction (MGD) is common in patients with and without chronic ocular graft-versus-host disease (coGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), according to a study in The Ocular Surface. The researchers report that MG changes were similar among patients with or without coGVHD. However, patients with coGVHD experienced more inflammation and fibrosis, the report shows. 

Between October, 2019 and April, 2021, researchers conducted a prospective cross-sectional study of 79 patients (47 with coGVHD and 32 without) after allo-HSCT. The mean patient age was 36.4±11.5 years, and 64.6% were men. The participants completed an ocular surface disease index (OSDI) questionnaire, and underwent slit lamp, ocular surface interferometer, meibography and confocal microscopy examination. Investigators compared the prevalence and severity of MGD between both groups and related factors were analyzed. The main study outcome measures were lipid layer thickness (LLT) and meiboscore. 

The researchers identified a similar prevalence of MGD in coGVHD and non-coGVHD groups (87.2% vs 84.4%, P =.977). Among those with MGD, patients without coGVHD had longer noninvasive break-up time [5.54 (2.87, 9.37) vs 2.29 (0.00, 3.82) s, P <.001]. However, both groups showed similarly decreased LLT (53.5±22.3 vs 47.1±25.2 nm, P =.286, increased meiboscore (2.7±1.5 vs 3.5±1.8, P =.060) and enlarged acinar unit area (1647.7±942.9 μm2 vs 1808.8±1211.5 μm2P =.592). 

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The team observed meibomian gland inflammation and fibrosis among both groups, but more so in the coGVHD group. 

Due to the potential confounding influence of time interval after allo-HSCT, same comparisons for MGD parameters were conducted in patients whose time interval ranged from 6 months to 24 months. According to the report, the results reveal that the time interval between both groups were matched.

Regression analysis showed that LLT or meiboscore was not associated with coGVHD severity. LTT was positively associated with systemic immunosuppressant use (β =12.0, P =.044), while meiboscore was positively related with lymphoma (β =1.78, P =.040) and matched unrelated donor (β =1.59, P =.008).

“Ocular surface pathologies might develop before coGVHD, and even before allo-HSCT,” the researchers explain. “Therefore, pre-HSCT detailed ocular examination and regular screening of MGD are again advocated.” 

Limitations of the study include its small sample size, lack of patients with lymphoma, and selection bias due to the single center design and the exclusion of patients with long-term use of topical medications. Further, a few patients with severe symblepharon and corneal perforation were excluded because they were unable to undergo certain examinations. 


Zhao W, Yang J, Liao Y, et al. Comparable meibomian gland changes in patients with and without ocular graft-versus-host disease after hematopoietic stem cell transplantation. Ocul Surf. Published online April 5, 2022. doi:10.1016/j.jtos.2022.04.002