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Cornea & External Diseases




















Non Infectious
Rose bengal staining of the conjunctiva and cornea in a patient with KCS.
Keratoconjunctivitis sicca (KCS) in two different patients with history of bone marrow transplantations.

  • Common after bone marrow transplantation.
  • Some ocular manifestation such as keratoconjunctivitis sicca (KCS), sterile conjunctivitis, cicatricial lagophthalmos, cataracts and retinal microvascular occlusive disease have commonly observed in patients with GVHD.
  • KCS is the most significant ocular complication associated with acute and chronic GVHD.
  • Clinical features:
    • Symptoms:
      • Foreign body sensation, itching, burning and moderate conjunctival redness
      • Decreased vision, pain and photophobia usually occur in advanced cases
      • Exacerbated by wind, blinking or prolonged reading.
    • Signs:
      • Minimal or absent tear meniscus
      • Mucus threads and conjunctival hyperemia
      • Fine, medium or coarse epithelial keratitis
      • Filamentary keratitis may be found especially in the interpalperal fissure
      • Epithelial erosion, subsequent stromal ulceration and recurrent corneal infections may occur in more severe cases.
  • Complications include corneal scarring, neovascularization or conjunctivalization of the cornea.
  • Management:
    • Vigorous surface lubrication with artificial non-preservativeartificial tears or ointment.
    • Treatment of associated systemic diseases.
    • Punctal occlusion.
    • Humidifiers or moisture chambers to decrease tear film evaporation.
    • Surgical tarsorraphy for intractable dry eye.

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