. Author manuscript; available in PMC: 2020 Feb 1.

Published in final edited form as: Biol Blood Marrow Transplant. 2018 Nov 24;25(2):e46–e54. doi: 10.1016/j.bbmt.2018.11.021

Table 4.

Recommendations for evaluation and treatment of ocular GVHD

Recommendation	Level
Evaluation by an ophthalmologist
Before transplantation	A-III⁴⁸
Between 3 and 6 months after HCT in all patients	A-II^{3, 49}
At diagnosis of chronic GVHD in any site	A-III⁵⁰
First-line systemic treatment for ocular GVHD^*
Corticosteroids	A-I^{7, 50, 55}
Second or subsequent-line systemic treatment for ocular GVHD^*
Extracorporeal photopheresis	C-II^58-61
Rituximab	C-II^{61, 62}
Sirolimus	C-II^{63, 64}
Mycophenolate mofetil	C-II^66-68
Topical treatment
Preservation-free artificial tears or gels	A-II^{8, 56, 69}
Viscous ointment/tears	A-II^{8, 56}
Cyclosporine	B-I^{86, 88, 89}
Tacrolimus	B-I^{91, 92}
Punctal plugs	B-II^{78, 79}
Corticosteroids	B-II^{8, 90}
Warm compresses, lid hygiene	B-II⁸⁵
Scleral lenses	B-II^80-83
Tranilast	B-II⁹⁴
Mucin secretagogues	B-II^{42, 70}
Occlusive eye wear	B-II⁸⁴
Antibiotic eye drops or ointment	B-III⁸
Autologous serum eye drops	C-II^73-76
Platelet derived eye drops	C-II⁷⁷
Inhibitor of Janus and spleen tyrosine kinases	C-II⁹³
Partial tarsorrhaphy	C-II⁸
Superficial epithelial debridement	C-III⁸
Amniotic membrane transplantation	C-III⁹⁷
Limbal stem cell transplantation and keratoplasty	C-III^{98, 99}
Other treatment
Low-dose oral tetracycline/doxycycline	B-II⁸⁷
Oral omega-3 fatty acid supplement	C-I^{71, 72}

Systemic treatment for chronic GVHD is generally not used for isolated eye involvement or without topical treatment.