Wenn Tränenersatzmittel nicht mehr ausreichen: die Bedeutung von Entzündungsprozessen beim Trockenen Auge. Praktische Aspekte einer antientzündlichen Therapie des Trockenen Auges

Abstract

ZusammenfassungDas Trockene Auge stellt eine heterogene Erkrankung der Augenoberfläche dar. Das Krankheitsbild hat multifaktorielle Ursachen und geht normalerweise mit einer Erhöhung der Osmolarität des Tränenfilms und mit Entzündungsprozessen der Gewebe der Augenoberfläche einher. Die Bedeutung der Entzündung beim Trockenen Auge geht nicht zuletzt auch aus der aktuellen Definition des Dry Eye Workshops (DEWS) hervor. Das Verständnis der Pathomechanismen und therapeutischen Möglichkeiten für diese Entzündungsprozesse ist daher für das Management des Trockenen Auges von zentraler Bedeutung. Der Beitrag fasst den aktuellen Kenntnisstand zum Thema „Entzündung und Trockenes Auge“ zusammen und versucht, praktische Empfehlungen für die Diagnostik, Verlaufskontrolle und die Anwendung der aktuell verfügbaren Therapieoptionen für die dem Trockenen Auge zugrunde liegenden Entzündungsprozesse zu geben.

A Narrative Review of Current Understanding and Classification of Dry Eye Disease with New Insights on the Impact of Dry Eye during the COVID-19 Pandemic

“…DED is a heterogenous condition; symptoms may be variable and inconsistent with the changes observed at the ocular surface [ 5 , 7 , 13 , 17 ]. Signs and symptoms can appear similar to those reported in cases of ocular infection or allergy [ 7 , 13 , 17 ].…”

“…DED is a heterogenous condition; symptoms may be variable and inconsistent with the changes observed at the ocular surface [ 5 , 7 , 13 , 17 ]. Signs and symptoms can appear similar to those reported in cases of ocular infection or allergy [ 7 , 13 , 17 ]. The published TFOS DEWS II report includes criteria for diagnosis and appropriate testing recommendations, and the ODISSEY European Consensus Group has proposed a diagnostic algorithm to assist in the grading of severity as well as monitoring of ongoing disease progression [ 13 , 18 ].…”

“…Identification of ocular surface inflammation is critical in making an accurate diagnosis and grading the severity of disease [ 17 ]. Many people with DED will present with conjunctival or eyelid hyperaemia and this typically indicates the presence of inflammation at the ocular surface, although inflammation may also be present in those without obvious signs of hyperaemia [ 17 ].…”

“…Identification of ocular surface inflammation is critical in making an accurate diagnosis and grading the severity of disease [ 17 ]. Many people with DED will present with conjunctival or eyelid hyperaemia and this typically indicates the presence of inflammation at the ocular surface, although inflammation may also be present in those without obvious signs of hyperaemia [ 17 ]. Osmolarity testing and identification of pro-inflammatory biomarkers such as metalloproteinase-9 (MMP-9) may be helpful in identifying evidence of ocular surface inflammation [ 5 , 17 , 20 ].…”

“…Many people with DED will present with conjunctival or eyelid hyperaemia and this typically indicates the presence of inflammation at the ocular surface, although inflammation may also be present in those without obvious signs of hyperaemia [ 17 ]. Osmolarity testing and identification of pro-inflammatory biomarkers such as metalloproteinase-9 (MMP-9) may be helpful in identifying evidence of ocular surface inflammation [ 5 , 17 , 20 ]. However, mild/moderate disease (type I or type II DED) can be overlooked during assessments with these technologies as compensatory mechanisms within the eye (e.g.…”