Current diagnosis and management of ocular graft-versus-host disease at a tertiary cancer center

Ocular graft-versus-host disease (oGVHD) remains one of the most challenging complications of allogeneic hematopoietic stem cell transplantation (HSCT), often leading to severe ocular surface morbidity and irreversible vision loss if not properly managed. Diagnostic uncertainty persists due to variability in clinical presentation and a lack of universally accepted criteria, but the greatest clinical burden lies in establishing effective, durable treatment protocols. Current strategies range from lubricants and topical immunomodulators to advanced surgical interventions; however, outcomes remain inconsistent due to delayed recognition and heterogeneous practices across institutions. At institutions like MD Anderson Cancer Center (MDACC), a structured treatment strategy has been developed that emphasizes early recognition and targeted therapy based on the specific ocular tissues affected. This approach integrates patient-reported outcomes with objective ocular findings and applies stepwise therapeutic escalation aligned with tissue-specific pathology. This review offers a brief overview of the clinical burden and pathophysiology of oGVHD, outlines the key diagnostic challenges, and a more detailed discussion on therapeutic strategies with particular emphasis on the targeted tissue-based approaches