Cornea
Corneal Graft Rejection
Also known as: corneal graft rejection, corneal transplant rejection, graft rejection, keratoplasty rejection, penetrating keratoplasty rejection, endothelial rejection, Khodadoust line, RSVP graft rejection
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Immune rejection of a corneal transplant is sight-threatening and time-sensitive. The key patient-facing warning pattern is RSVP: Redness, Sensitivity/photophobia, Vision decrease, and Pain. Optometry should recognise the pattern, look for infection or loose suture mimics, document graft findings, and arrange urgent same-day cornea specialist/ophthalmology review. Steroid escalation is specialist-managed and should not be presented as an optometrist prescribing CTA.
Recognition
Symptoms: what patients report
- Redness in an eye with a corneal graft.
- Sensitivity to light / photophobia.
- Vision decrease, blur, haze, glare, or reduced clarity.
- Pain, ache, or new discomfort.
- Recent missed steroid drops, recent inflammation, trauma, infection, or graft surgery may increase risk.
Signs: what the examination shows
- Graft oedema, haze, or reduced graft clarity.
- Keratic precipitates on the graft endothelium.
- Endothelial rejection line / Khodadoust line if present.
- Anterior chamber cells/flare.
- Ciliary injection, epithelial rejection changes, or stromal inflammation may be present.
- Loose/broken sutures, epithelial defect, infiltrate, or discharge suggests infection or suture-related keratitis rather than isolated rejection.
What OptoGuide™ covers for corneal graft rejection
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Corneal transplant rejection — College of Optometrists CMG
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Causes of Corneal Transplant Failure: A Multicentric Study. Gómez-Benlloch A, Montesel A, Pareja-Aricò L, et al. Acta Ophthalmologica. 2021;99(6):e922-e928.
- PCR testing for herpesviruses in aqueous humor samples from patients with and without clinical corneal endothelial graft rejection. Abu Dail Y, Daas L, Flockerzi E, et al. Journal of Medical Virology. 2024;96(3):e29538.
- Distinguishing Features of Anterior Uveitis Caused by Herpes Simplex Virus, Varicella-Zoster Virus, and Cytomegalovirus. Terada Y, Kaburaki T, Takase H, et al. American Journal of Ophthalmology. 2021;227:191-200.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.