Keratoconjunctivitis sicca

Classification according to ICD-10
H04.1	Keratoconjunctivitis sicca, in the sense of dry eye syndrome
ICD-10 online (WHO version 2019)

The keratoconjunctivitis sicca (short KCS ) (from lat. Siccus dry '), also known as dry eye syndrome called, is a featured by dryness of the eye disease picture of ophthalmology. Typical symptoms are reddening and burning of the eyes, together with a feeling of foreign bodies, which are caused by a disruption of the tear film . This disruption of the tear film can be due to insufficient production of tear fluid or to an incomplete structure of the three-layer tear film. For therapy, eyelid margin hygiene, tear substitutes , liposomal eye spray and, if necessary, other agents are used. If the KCS is not treated, this can lead to persistent, sometimes very stressful symptoms, to a constant intensification of the inflammatory processes in the eye, which leads to increased dryness of the eyes, which can further intensify the inflammatory processes up to permanent damage to the eye Eye in severe disease.

The term "keratoconjunctivitis sicca" was coined in the early 1930s by the Swedish ophthalmologist Henrik Sjögren in the course of researching Sjögren's syndrome . The term sicca syndrome was derived from this and includes keratoconjunctivitis sicca as part of the sicca symptoms.

causes

VDU work (Office Eye Syndrome, Gamer Eye for computer gamers)
Environmental pollution
contact lenses
low humidity / air conditioning
hormonal changes, e.g. B. Testosterone Deficiency in Old Age
Medication e.g. B. beta blockers , the "pill" or treatment with anti-androgens and inhibitors of androgen synthesis, z. B. in prostate cancer or permanent local application of hair restorers based on such substances
Inflammation of the eyelid margin ( blepharitis )
Rosacea
Allergies
Stem cell transplants inf. a graft-versus-host reaction
Autoimmune diseases (e.g. Sjogren's syndrome )
Vitamin A deficiency
Eye surgery such as B. Lasik, cataract surgery, refractive surgery
Rheumatoid Arthritis and Similar Autoimmune Diseases
Imbalance of extracellular DNA and nuclease activity on the surface of the eye: On the surface of the eye of patients with keratoconjunctivitis sicca (Dry Eye Disease [DED]), extracellular DNA (eDNA) and extranuclear chromatin from neutrophil granulocytes (NETs) are found in the mucoid film consists of eDNA, histones, cathlicidin and neutrophil elastase. The nuclease activity in the tear fluid of DED patients was reduced; on the other hand, the amount of eDNA on the surface of the eye was increased. It can be concluded that the production of extracellular DNA and its clearance mechanisms are dysregulated in patients with DED. The hypothesis is currently being tested that nuclease deficiency in the tear fluid enables the accumulation of eDNA and NETs in the precorneal tear film contribute to the inflammation of the surface of the eye.

frequency

Dry eye is one of the most common diseases in ophthalmology, the prevalence increasing with age and being around 15-17% of the total population. It is therefore also classified as a widespread disease .

Diagnosis

clinical changes, such as tear film and corneal abnormalities

Determination of the tear film break-up time (also BUT after break-up time) and thus the stability of the tear film

Staining of defects in the conjunctiva and cornea with fluorescein

Staining devitalized but still intact cells with rose bengal or lissamine

Schirmer test with an insert of filter paper to determine the amount of tear secretion

In severe or therapy-resistant cases, if necessary, thorough examination including hormone status , determination of rheumatoid factors , conjunctival smear

Examination of blink frequency, eyelid position, eyelid closure and eyelid margins

Occurrence of eyelid inflammation

Therapy options

The treatment of dry eye is usually carried out by improving the tear film with simultaneous suitable local and systemic treatment of any underlying diseases (blepharitis, Sjögren's syndrome, etc.)

In the hypovolemic form: replacement / supplementation of the aqueous phase of the tear fluid with tear substitutes (artificial tears are instilled in the open eye in the form of eye drops or introduced into the conjunctival sac of the eye as eye gel ). They consist of aqueous solutions of thickeners (e.g. povidone , hydroxypropylmethyl cellulose , carboxymethyl celluloses and / or trehalose ), salts and, if necessary, other ingredients (e.g. hyaluronic acid , dexpanthenol ). Preservative-free preparations are available to prevent allergies .

In the hyperevaporative form: Improvement of the meibomian gland function (e.g. through eyelid edge hygiene) and supplementation of the superficial lipid layer of the tear film with lipid-containing tear substitutes or liposomal eye spray (is sprayed on the closed eyes, reaches the tear film via the eyelid margins and stabilizes the lipid layer in the process ).

Replacement of the tear film and reduction of the shear forces between the surface of the eye and the eyelid during eyelid movements with ointments containing fat (O / W emulsions). Often used to treat dry eye at night.

Insertion of punctum plugs into one or both lacrimal punctures . Depending on the design, the plugs can remain permanently in the puncta or dissolve after a few weeks. Disadvantages: The retention of the tear fluid also means that the inflammation-promoting substances in the tear fluid, which has a different composition in the dry eye, remain on the eye longer. The reduced drainage of tear fluid through the draining tear ducts caused by the plugs can promote infections caused by bacteria that rise from the nasal cavity.

In suitable cases, further therapies try to suppress the underlying inflammatory processes in the eye in addition to improving the tear film.

Cyclosporin A solution (trade name Ikervis ) or oily solution (0.05% in vegetable oil, in-house production by German pharmacies)
Lifitegrast eye drops ( Xiidra ), only approved in the USA
Own serum (tested in several German university eye clinics in 2007)
Androgens (external use on the eyelid; currently in phase IIb clinical trials in the US). This therapeutic approach takes up the knowledge that the inflammatory processes are strongly androgen-dependent. Androgens also have an anti-inflammatory effect on the eye.
Blephasteam thermal goggles, new therapy option for a meibomian gland disorder (blepharitis).

Web links

General information (PDF; 114 kB) of the Professional Association of Ophthalmologists (BVA)
Artificial tears are not always enough , article in the Neue Zürcher Zeitung about the KCS
Review article on current findings on the causes and therapies. Pharmaceutical newspaper online
Sicca Syndrome Information
Self-help group dry eyes , helpful exchange of experiences between those affected

literature

U. Pleyer: Inflammatory Eye Diseases . Springer-Verlag, 2014, pp. 119 ff. ISBN 9783642384196
C. Jacobi, T. Dietrich, C. Cursiefen, FE Kruse: The dry eye. Current concepts for classification, diagnostics and pathogenesis. In: The ophthalmologist. 2006 Jan; 103 (1), pp. 9-17. (Review), PMID 16365732
C. Cursiefen, C. Jacobi, T. Dietrich, FE Kruse: Current therapy for dry eyes. In: The ophthalmologist. 2006 Jan; 103 (1), pp. 18-24. (Review), PMID 16362353
K. Kasper, L. Godenschweger, D. Hartwig, JD Under Run, B. Seitz, G. Geerling: ON state of the use of autologous serum eye drops in Germany. In: The ophthalmologist. 2008 Jul; 105 (7), pp. 644-649, PMID 18612645
W. Trattler, D. Katsev, D. Kerney: Self-reported compliance with topical cyclosporine emulsion 0.05% and onset of the effects of increased tear production as assessed through patient surveys. In: Clin Ther . 2006 Nov; 28 (11), pp. 1848-1856, PMID 17213005
MA Lemp, AJ Bron, C. Baudouin, JM Benítez Del Castillo, D. Geffen, J. Tauber, GN Foulks, JS Pepose, BD Sullivan: Tear osmolarity in the diagnosis and management of dry eye disease. In: Am J Ophthalmol. 2011 May; 151 (5), pp. 792-798.e1, PMID 21310379
S. Uhrig: The treatment of sicca syndrome (dry eye) from the perspective of Chinese medicine. In: Chinese Medicine. 2006; 21, pp. 129-135.

Individual evidence

↑ A. Jaksche: The dry eye , University Eye Clinic Bonn. ( Memento of the original from December 22, 2015 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2
↑ Snehal Sonawane, Vishakha Khanolkar, Abed Namavari, Shweta Chaudhary, Sonal Gandhi, Sapna Tibrewal, Sarmad H. Jassim, Brittany Shaheen, Joelle Hallak, John H. Horner, Martin Newcomb, Joy Sarkar, Sandeep Jain: Ocular Surface Extracellular DNA and Nuclease Activity Imbalance: A New Paradigm for Inflammation in Dry Eye Disease . In: Invest Ophthalmol Vis Sci. 2012, doi : 10.1167 / iovs.12-10430 .
↑ Guideline No. 11 of the Professional Association of Ophthalmologists in Germany (BVA): "Dry eye" (Sicca syndrome)
↑ Dry eyes. Retrieved September 28, 2019 .

[jaksche-1] A. Jaksche: The dry eye , University Eye Clinic Bonn. ( Memento of the original from December 22, 2015 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2

[2] Snehal Sonawane, Vishakha Khanolkar, Abed Namavari, Shweta Chaudhary, Sonal Gandhi, Sapna Tibrewal, Sarmad H. Jassim, Brittany Shaheen, Joelle Hallak, John H. Horner, Martin Newcomb, Joy Sarkar, Sandeep Jain: Ocular Surface Extracellular DNA and Nuclease Activity Imbalance: A New Paradigm for Inflammation in Dry Eye Disease . In: Invest Ophthalmol Vis Sci. 2012, doi : 10.1167 / iovs.12-10430 .

[3] Guideline No. 11 of the Professional Association of Ophthalmologists in Germany (BVA): "Dry eye" (Sicca syndrome)

[4] Dry eyes. Retrieved September 28, 2019 .