Tear osmolarity in ocular graft-versus-host disease

Luigi Berchicci, Lorenzo Iuliano, Elisabetta Miserocchi, Francesco Bandello, Giulio Modorati

Research output: Contribution to journalArticlepeer-review


Purpose: The aim of this study was to evaluate tear osmolarity in patients with chronic graft-versus-host disease (cGVHD) with ocular involvement. Methods: In this observational cross-sectional study of 56 patients with ocular cGVHD referred to the tertiary-care Ocular Immunology and Uveitis Service at the San Raffaele Scientific Institute, Milan, from May 2010 to November 2013, we evaluated the following clinical parameters: Ocular Surface Disease Index (OSDI) symptoms questionnaire, tear osmolarity, Schirmer test, tear film break-up time (TBUT), corneal and conjunctival staining. Results: All patients developed systemic GVHD after undergoing allogeneic hematologic stem cell transplantation. Mean osmolarity was 314.0 ± 22.1 mOsm/L, mean OSDI score was 26.4 ± 21.2, mean TBUT was 6.50 ± 4.75 seconds, and mean Schirmer test value was 3.8 ± 3.3 mm. Tear osmolarity significantly inversely correlated with TBUT (r2 = 0.681; P <0.001). Statistically significant inverse correlation was present with the Schirmer test (r2 = 0.203; P, 0.001), and positive correlation with the OSDI score (r2 = 0.188; P <0.001), but both with low correlation strength. Osmolarity was statistically different in the subgroups according to the Oxford corneal staining scale (P = 0.0006) and to the van Bijsterveld conjunctival staining score (P = 0.006). Conclusions: Tear osmolarity increased in patients with ocular cGVHD, significantly correlated with TBUT and, to a lesser extent, with the Schirmer test value and OSDI. These results emphasize the role of aqueous-deficient and evaporative dry eye disease in patients with cGVHD after undergoing allogeneic hematologic stem cell transplantation. Tear osmolarity may be considered a useful test in diagnostic assessment of dry eye disease associated with cGVHD.

Original languageEnglish
Pages (from-to)1252-1256
Number of pages5
Issue number12
Publication statusPublished - 2014


  • Dry eye disease
  • Graft-versus-host disease
  • Tear osmolarity

ASJC Scopus subject areas

  • Ophthalmology
  • Medicine(all)


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