Membranous Conjunctivitis in Acute and Chronic Graft-Versus-Host Disease: Longitudinal Ocular Outcomes

To characterize longitudinal ocular surface outcomes and survival in a contemporary cohort of patients with membranous conjunctivitis (MC) after allogeneic hematopoietic cell transplantation (HCT).

Retrospective review of serial ocular assessments performed on patients from baseline through 12-18 months post-HCT as part of the transplant clinical trials at the National Institutes of Health (NIH) Clinical Center. These exams included ocular symptoms, Schirmer's test (ST), conjunctival redness (CR), tear breakup time (TBUT), and corneal staining (COS) and fibrosis assessment. Survival was analyzed from HCT and MC diagnosis.

MC occurred in 32/369 patients (8.6%) and was associated with acute (28.1%) or chronic (65.6%) graft-versus-host disease (GVHD); two patients (6.3%) had isolated MC without systemic GVHD. MC preceded or coincided with systemic GVHD diagnosis in 46.9% of patients. Median time from HCT to MC was 116 days (range 31 to 1126). The most common presenting symptoms were noninfectious mucoid discharge (50%) and foreign body sensation (37.5%). Tear volume declined by 70.2% at MC diagnosis and remained persistently reduced throughout follow-up. CR and COS increased (both P<0.001), whereas TBUT decreased (P=0.005) and remained abnormal. Subtarsal fibrosis developed in 72.4% of surviving patients. Two-year survival was 50% from both HCT and MC diagnosis.

Membranous conjunctivitis is a severe inflammatory ocular GVHD phenotype that occurs in both acute and chronic GVHD and is associated with persistent tear dysfunction and conjunctival fibrosis, underscoring the importance of pre-HCT ophthalmic examination and post-HCT surveillance for early recognition and coordinated multidisciplinary management.