[CIS PIDD] [cis-pidd] Eye disease in CVID

Wed Nov 30 11:47:20 EST 2016

You don't say if the IgG is endogenous or supplemented. I had a similar
patient who problem resolved on IG supplementation. If she is already being
supplemented, I think you are left with local treatment. I wonder if anyone
has tried IG as an eye drop?
Richard Wasserman
Dallas

On Wed, Nov 30, 2016 at 10:36 AM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
wrote:

> In the GvH setting, we’ve used cyclosporine eye drops (restasis). There
> was a study on a CsA implant, but I don’t think that that is commercially
> available (paper attached). If the ophthalmologist wants objective evidence
> of ocular autoimmunity prior to using restasis, he could do a meibomian
> gland biopsy. A number of meibographic techniques have been described as
> well, and the ophthalmologist might be familiar with that as a non-invasive
> alternative
>
> -R
>
>
>
>
>
> --
>
> *Rob Sokolic, MD*
> *Medical Officer      *
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>
> *Center for Biologics Evaluation and Research Office of Tissues and
> Advanced Therapies U.S. Food and Drug Administration*
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> *From:* CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org]
> *Sent:* Wednesday, November 30, 2016 11:14 AM
> *To:* CIS-PIDD
> *Subject:* [cis-pidd] Eye disease in CVID
>
>
>
> Dear colleagues,
>
>
>
> We have a 55-yo white female with CVID, who has suffered from severe
> bilateral blepharitis, episcleritis, and dry eye for 2 years now to the
> point that she has lost all eyelashes. So far there is no evidence of
> uveitis or retinal diseases. No improvement from steroids eye drops or oral.
>
>
>
> Her ophthalmologist is at a loss in how to proceed. I was wondering if her
> eyelid and scleral diseases are related to CVID. She is otherwise doing
> well from infection standpoint, IgG levels >1,000 on IVIG, IgA 10s, and IgM
> 20-30s. She does not have dry mouth, autoimmune manifestations, or lymphoid
> infiltrations. Her T, B cell counts and their subsets are normal.
>
>
>
> Does anyone have experience with CVID patients like this? I would
> appreciate comments or suggestions. I looked up the literature and most
> reports of eye diseases in CVID are more of uveitis or retinal diseases,
> similar to those seen in sarcoidosis.
>
>
>
> Thank you,
>
> Panida
>
>
>
> *Panida Sriaroon, MD*
>
> *Associate Professor*
>
> *Associate Director, Fellowship Program*
>
> *Medical Director, USF/All Children's Hospital Allergy/Immunology clinic*
>
> *E-mail  psriaroo at health.usf.edu <psriaroo at health.usf.edu>*
>
>
>
>
>
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-- 
Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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