Vaccination is safe after corneal transplantation

Take a short course of steroid eye drops to protect from transplant rejection

When it comes up to the flu season, and especially now in the midst of the COVID-19 emergency, we are often contacted by our transplant patients asking whether it is safe to have a vaccination, or whether this could trigger a corneal transplant rejection episode?

The answer is that you should go ahead with vaccination if it is available to you. Evidence that corneal transplantation rejection episodes can be triggered by vaccination is weak, and limited to a few case reports. Yes, vaccines stimulate the immune system, but so does infection; and any risk of damaging your corneal transplant by having vaccination is extremely small.

To cover this risk, we recommend taking a short course of steroid eye drops starting from the day of vaccination. Your family doctor can prescribe these drops for you, and you can pick the prescription up when you attend for vaccination or pick it up at your local pharmacy if you are having the vaccine there. Although starting drops two days before having the vaccine has been recommended by my colleagues Frank and Marianne Price, from a leading corneal practice in the USA, starting on the day is likely to be equally effective, and is often more convenient.

We would recommend:

Dexamethasone or Pred Forte eye drops four times daily for two weeks starting from the day of vaccination

If you are still taking a low dose of steroid eye drops after a recent corneal transplant, simply increase those drops to four times daily for two weeks from the day of the vaccination. You do not need a new prescription.

Rejection episodes can occur at any time after a corneal transplant. So, remember ‘RSVP’: if you experience Redness, Sensitivity to light, Visual blurring, or Pain in your eye, you should always attend for emergency review. Treatment for corneal transplantation is more effective if it is started early.

Do not let having a corneal transplant be an excuse to avoid vaccination. Just take a short course of steroid eye drops each time you are vaccinated.