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Abstract: Eyelid laxity in GvHD patients

Ocul Surf. 2018 Oct 12. pii: S1542-0124(18)30234-9. doi: 10.1016/j.jtos.2018.10.005. [Epub ahead of print]

Eyelid metrics assessment in patients with chronic ocular graft versus-host disease.

Giannaccare G, Bernabei F, Pellegrini M, Arpinati M, Bonifazi F, Sessa M, Versura P, Campos E.



To assess eyelid metrics in the setting of chronic ocular graft versus-host disease (oGVHD), and to further correlate them with hematological and ocular characteristics.


Prospective case-control study conducted at a single tertiary-referred Center. The following eyelid tests were performed in oGVHD patients and control subjects: vertical lid pull; anterior/lower distraction; lateral/medial distraction; distance between lateral canthal angle and orbital rim; margin reflex distances (MRD) 1 and 2; duration of tarsus exposure; snap back. Correlations of eyelid metrics with hematological and ocular parameters in the oGVHD group were performed.


Twenty-seven patients with oGVHD and 27 healthy matched subjects were finally included. Significantly higher values of vertical lid pull, anterior/lower distraction, lateral/medial distraction, and distance between lateral canthal angle and orbital rim were found in the oGVHD group compared to controls (always p < 0.02). Conversely, MRD1 was lower in oGVHD patients compared to controls (p < 0.001). Duration of tarsus exposure and snap back test were pathological in a higher percentage in oGVHD group compared to controls (respectively 66.7 and 59.3% vs 33.3 and 25.9%; p < 0.005). Vertical lid pull test was significantly higher in oGVHD patients with superior limbic keratoconjunctivitis (13.8 ± 2.4 vs 10.9 ± 2.4, p = 0.010). Ocular GVHD patients with subtarsal fibrosis had a higher percentage of pathological values for duration of tarsus exposure test (77.3 vs 20.0%; p = 0.014).


The present study highlighted for the first time higher eyelid laxity in oGVHD patients. This intriguing association may add a further piece to the puzzle of clinical features occurring in the setting of oGVHD.