Ocular Immersion Hydrotherapy Effectively Alleviate Symptoms and Signs of Severe Dry Eye Secondary to Ocular Graft-Versus-Host Disease in a Short Term.

Purpose: To report a novel ocular immersion hydrotherapy (OIH) to manage patients with severe dry eye secondary to ocular graft-versus-host disease (oGVHD) and clinical outcomes after treatment. Methods: This case series included five consecutive patients with severe oGVHD-related dry eye who had previously undergone unsuccessful long-term conventional treatments. All five patients received an OIH treatment for a week. Visual acuity, Schirmer's test (ST) without anesthesia, slit-lamp examination, fluorescein corneal staining, and in vivo confocal microscopy were recorded before and after treatment. The corneal fluorescein staining was evaluated using the National Eye Institute (NEI) scale. The Ocular Surface Disease Index (OSDI) score was utilized to assess the severity of symptoms. Concentrations of IL-2 and IL-6 in tear fluid were quantified in another group of patients with oGVHD and dry eye disease (DED) at baseline, immediately following artificial tear instillation, and at 30 and 60 min postapplication. Findings: Following the OIH treatment in a short term, all patients exhibited significant improvement in both symptoms and signs, as evidenced by a substantial reduction in OSDI scores compared to pretreatment levels and a significant decrease in corneal fluorescein staining scores. In vivo confocal microscopy also indicated a reduction in inflammation. The concentrations of IL-2 and IL-6 in the tears of oGVHD patients are significantly higher than those in DED patients. Although artificial tear application transiently reduces the levels of both cytokines, they rebound to near-baseline values within approximately 1 hour. Implications: Conventional treatments are often inadequate for managing severe and refractory dry eye secondary to oGVHD, leaving patients to suffer from severe symptoms. The novel OIH treatment approach presented in this study significantly promotes corneal epithelial healing, alleviates symptoms, and improves clinical signs, demonstrating good tolerability in a short term. Further long-term studies with more patients are demanded.