Topical Spironolactone in Ocular Graft-versus-Host Disease
Main Article Content
Abstract
Ocular graft-versus-host disease (oGVHD) is a serious complication of allogeneic hematopoietic stem cell transplantation that causes chronic inflammation, fibrosis, and dysfunction across multiple ocular tissues, including the lacrimal glands, cornea, conjunctiva, and meibomian glands. Common symptoms such as dryness, visual disturbances, and ocular discomfort are often resistant to standard treatment. Current therapies provide partial relief, rarely reverse structural damage, and typically target a limited range of immune or fibrotic pathways.
Spironolactone, a mineralocorticoid receptor antagonist, has emerged as a promising candidate due to its ability to block pathological mineralocorticoid signaling. This pathway becomes abnormally active in ocular tissues with low levels of the enzyme 11β-hydroxysteroid dehydrogenase type 2, leading to unchecked inflammation and tissue remodeling.
This review outlines the immunopathology of oGVHD in four key anatomical sites and evaluates spironolactone’s potential effects. In the lacrimal glands, spironolactone reduces inflammatory cytokines, limits fibroblast activation, and helps preserve tear production. In the cornea and conjunctiva, it supports epithelial barrier integrity, reduces surface inflammation and fibrosis, and enhances healing. In the meibomian glands, it improves lipid secretion and prevents glandular dropout. Preclinical and early clinical studies show that topical spironolactone improves both objective markers, such as corneal fluorescein staining and lid margin health, and subjective symptoms, with minimal side effects.
Spironolactone’s anti-inflammatory, antifibrotic, lipid-enhancing, and epithelial-protective properties position it as a potential disease-modifying therapy for oGVHD. While additional studies are needed to confirm its protective role and long-term efficacy, current evidence suggests that spironolactone may address important unmet needs in the management of this complex condition.
Keywords:
ocular graft versus host disease, spironolactone, mineralocorticoid receptor, dry eye, inflammation
Article Details
How to Cite
PATIL, Rugveda R. et al.
Topical Spironolactone in Ocular Graft-versus-Host Disease.
Medical Research Archives, [S.l.], v. 13, n. 9, sep. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6822>. Date accessed: 05 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i9.6822.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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