Surgical treatment of dry eye

Diagnosis and Treatment of Ocular Chronic Graft-Versus-Host Disease: Report From the German–Austrian–Swiss Consensus Conference on Clinical Practice in Chronic GVHD

“…Moreover, the consensus was circulated among all transplant centers performing allogeneic HSCT in Germany, Austria, and Switzerland and was discussed during the Consensus Conference Meetings in Regensburg (November 2009) and Wiesbaden (May 2010). Overall, 58 German, Austrian, and Swiss transplant centers participated in the consensus conference representing 81% of all allogeneic HSCT centers. The Consensus Conference was organized under the auspices of the German working group on bone marrow and blood stem cell transplantation (DAG-KBT) and the German Society of Hematology and Oncology (DGHO), the Austrian Stem Cell Transplant Working Group of the Austrian Society of Hematology and Oncology, the Swiss Blood Stem Cell Transplantation (SBST) Group, and the German-Austrian Paediatric Working Group on Stem Cell Transplantation (Päd-Ag-KBT).…”

“…73 Surgical approaches to the ocular surface are often combined with a (permanent) partial tarsorrhaphy (see above) to decrease the exposed corneal area. 58,59 Limbal epithelial transplantation 74 and keratoplasty (corneal transplantation) have been described in patients with ocular cGVHD 32,75 ; however, the prognosis is markedly reduced in cases of ongoing dry eye disease and inflammatory conditions. In cases of membranous conjunctivitis with fornix adhesions, the application of an Illig shell may be necessary.…”

“…Bandage contact lenses should be used with extreme caution because of the risk of silent infections or asymptomatic perforations of the cornea. 57 Evaporation can also be reduced by a (permanent) partial tarsorrhaphy in severe cases in the chronic phase 58,59 or by botulinum toxin-induced ptosis in the acute phase.…”

Ophthalmologische Komplikationen beim Sjögren-Syndrom

“…Extrem schwere Formen des trockenen Auges können zusätzlich mit chirurgischen Therapieansätzen behandelt werden[8, 22,23]. Diese Gruppe von weniger als 1% aller Sicca-Patienten umfasst vor allem Patienten nach Bestrahlung und nach chronischer GvHD.…”

“…Weitere seltenere Verfahren umfassen die temporäre oder permanente Tarsorraphie, die induzierte Ptosis (Botulinum-Injektion), eine Bindehautdeckung oder in wenigen Extremvarianten, wie z. B. nach Radiatio, die Transposition von Speicheldrüsenausführungs-gängen[8, 22,23,32]. Schon lange ist bekannt, dass hormonelle Störungen, wie z.…”