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Ocular Surface Disease
Authors:
Alex Lange
Maciej Jesse
Vista Klinik Binningen
Table of Contents
Dry-Eye Syndrome
Rosacea
Seborrhoic blepharitis
Chalazion
Sarcoidosis
Ichthyosis
Ectodermal Dysplasia
Xeroderma pigmentosum
Noninflammantory Vascular Anomalies of
the Conjunctiva
• Herediatary Hemorrhagic Teleangiectasia
• Lymphangiectasia
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Nutritional Disorders
Exposure Keratopathy
Floppy Eyelid Syndrome
Superior Limbic Keratokonjunctivitis
Recurrent Corneal Erosion
Persistant Corneal Epithelial Defect
Neurotrophic Keratopathy
Trichiasis and Distichiasis
Mucus-fishing Syndrome
Dellen
Contact lens-related Problems
Limbal Stem Cell Deficiency
Dry—Eye Syndrome
• Definition: «Multifactorial disease of the tears and ocular surface that
results in symptoms of discomfort, visual disturbance, and tear-film
instability with potential damage to the ocular surface. It is
accompanied by increased osmolarity of the tear film and
inflammation of the ocular surface» (DEWS, 2007)
• Dry eye represents a disturbance of the lacrimal functionl unit (LFU),
consisting of the lacrimal glands, ocular surface (cornea, conjunctiva,
and meibomian glands), eyelids and the sensory nerves that connect
them
• LFU regulates the components of the tear film and responds to
environmental, endocrinologic, and cortical influences
Quelle: https://openi.nlm.nih.gov/detailedresult.php?img=PMC3587314_IRI-32-19-g001&req=4
Dry – Eye Syndrome
• Function of the LFU:
- Tear-film integrity (lubricating, antimicriobial, and nutritional roles)
- Ocular surface health (maintaining corneal transparency and surface
stem cell population)
- Quality of image projected onto the retina
Mechanism of Dry Eye
Core mechanisms
• Tear-film hyperosmolarity
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•
•
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inflammatory events leading to cell death by apoptosis
loss of goblet cells
disturbance of mucin expression
tear-film instability
• Tear-film instability exacerbates ocular surface hyperosmolarity ->
vicious circle
Dry Eye Syndrome - vicious circle
Figure from AAO, Basic and Clinical Science Course, Section 8 , 2013-2014.
Dry-Eye-Syndrome
• Other possible reasons for tear-film instability: xerosing medication,
xerophthalmia, ocular allergy, topical preservative use, contact lens
• Epithelial injury stimulates corneal nerve endings leading to
discomfort, increased blinking, compensatory reflex lacrimal tear
secretion -> may cause neurogenic inflammation within the lacrimal
gland
Classification: Major Etiologic Causes of dry Eye
1. Aqueous-deficient dry eye
2. Evaporative tear dysfuntion
3. Effect of environment
Figure from AAO, Basic and Clinica Science Course, Section 8 , 2013-2014.
Effect of the environment
• internal (low blink rate behavior, wide lid aperture gaze position,
aging, low androgen pool, systemic drugs)
• external (low relative humidity, high wind velocity, occupational
environment)
Dry-Eye Severity Grading Scheme
Severity level
1
2
Discomfort, severity,
frequency
Mild and/or episodic,
occurs under
environmental stress
Moderate episodic or
chronic, stress or no stress
Visual symptoms
None or episodic mild
fatigue
Annoying and/or activity
limiting episodic
Annoying, chronic and/or
constant, limiting activity
Constant and/or possibly
disabling
Conjunctival injection
None to mild
None to mild
+/-
+/++
Conjunctival staining
None to mild
Variable
Moderate to marked
Marked
Corneal staining
None to mild
Variable
Marked central
Severe punctate erosions
Corneal/tear signs
None to mild
Mild Debris, ↓meniscus
Filametary keratitis,
mucus clumping, ↑tear
debris
Filamentary keratitis,
mucus clumping, ↑tear
debris, ulceration
Lid/meibomian glands
MGD variably present
MGD variably present
Frequent
Trichiasis, keratinization,
symblepharon
TBUT (sec.)
Variabele
≤10
≤5
Immediate
Schirmer score (mm/5min)
Variabele
≤10
≤5
≤2
Dry Eye Workshop 2007 Oc Surf. 2007;5(2):75-92.
3
Severe frequent or
constant without stress
4
Severe and/or disabling
and constant
Sjögren Syndrome
• Can be divided into 2 clinical subsets: Primary SS and Secondary SS
• Primary SS includes patients who either have illdefined systemic immune
dysfunction or lack any evidence of immune dysfunction or conective
tissue disease
• Secondary SS occurs in patients with well-defined, generalized connective
tissue disease. Most commonly associated with rheumatoid arthritis
• Precise cause of aqueous tear deficiency (ATD) in SS is unknown, generally
considered to be a T-cell-mediated inflammatory disease leading to
destuction of the lacrimal gland
• Lacrimal gland cytology: focal oder diffuse lymphocytic infiltration
Sjögren Syndrome
Quelle: http://dgrh.de/?id=1679
Quelle: http://www.dermis.net/dermisroot/de/39368/image.htm
Non-Sjögren Syndrome
• ATD due to disease of lacrimal gland, lacrimal gland obstruction, or reflex
hyposecretion
• Primary lacrimal disease: Rilay-Day syndrome (familial dysautomia),
congenital alacrima, abscence of the lacrimal gland, anhidrotic ectodermal
dysplasia, Adie syndrome, idiopathic autonomic dysfunction (Shy-Drager
syndrome)
• Secondary lacrimal disease: sarcoidosis, chronic graft-vs-host disease, HIV,
xerophthalmia, and surgical ablation of the lacrimal gland, obstruction of
lacrimal outflow (cicatricial conjunctivitis)
• As a result of interruption of either the afferent or efferent limb of the
reflex arc (caused by eg, HSV, VZV, contact lens wear, peripheral
neuropathies, surgical disruption, PRK, PKP, ECCE, aging)
Meibomian Gland Dysfunction
• Result of progressive obstruction of the meibomian gland orifices due to
keratinization -> reduction of lipid delivery to the ocular surface and
increased inflammation of the eyelid charcterized by hyperemia of the
eylelid margin and tarsal conjunctival surface. Possible meibomian gland
dropout or displacement of the meibomian orifices.
• MGD classified into: obstructive, resulting from blepharitis, acne rosacea,
and pemphigoid and hypersecretory, resulting from meibomian seborrhea
• Leads to lipid tear deficiency, which results in tear-film instability, increased
rate of tear-film evaporation and elevated tear osmolarity
• Management: Eyelid hygiene, systemic tetracyclines, topical cortisteroids,
systemic omega-3 fatty acid supplements
Meibomian Gland Dysfunction
Quelle:http://www.eyecarepartners.co.uk/meibomian-gland-dysfunction-mgd.html
Recommended Treatment for Aqueous Tear Deficiency
Severity
Therapeutic Options
Mild
Artificial tears up to 4x/d
Lubricating ointment at bedtime
Hot compresses and eyelid massage
Moderate
Artificial tears AT 4x/d to hourly
Lubricating ointment at bedtime
Cyclosporin A AT 0.05% 2x/d
Reversible punctum plugs, lower puncta
Severe
All of the above
Punctum plugs (lower and upper)
Topical serum drops (20%) 4-6x/d
Topical corticosteroids
Moist environment
Tarsorrhaphy
Bandage lenses (rarely)
Rosacea
Chronic acneiform disorder that can affect both
the skin and eyes
Facial lesions
• Teleangiectasias
• Recurrent papules and pustules
• midfacial erythema
• +/- rhinophyma
Quelle: https://www.aad.org/public/diseases/acne-and-rosacea/rosacea
Ocular signs
• excessive sebum secretion
• chronic blepharitis
• eyelid margin telangiectasia
• meibomian gland dysfunction
• recurrent chalazia
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Chronic conjunctivitis
marginal corneal infiltrates
sterile ulceration
episcleritis,
iridocyclits
Rosacea
Causes
- No proven cause
- Flushing can be triggered by exposure to temperature
extremes, strenuous exercise, sunlight, sunburn, stress,
anxiety, cold wind, spicy foods and alcohol
Management
- Systemic tetracyclines, doxycycline, minocycline
- In addition topical metronidazole 0.75% gel or 1%
cream.
- Topical corticosteroids in case of noninfectious ulcerative
keratitis
Seborrhoic Blepharitis
• Seborrhoic Blepharitis may accur alone or in combination with
staphylococcal blepharitis or MGD
• Ocular signs: inflammation primarly at the anterior eyelid margin,
crusting on the eyelids, eyelashes, eyebrows, scalp, increased
meibomian gland secretion, associated keratitis or konjunctivitis, ATD
• Management: eyelid hygiene, treatment of scalp disease (coal tarbased shampoos), topical corticosteroids , systemic antibiotics (e.g.
doxycycline) in case of posterior blepharitis (eg, MGD). In case of
bacteria caused blepharitis (eg, staphylococcus) topical antibiotic
ointment (bacitracin, bacitracin-polymyxin B)
Seborrhoic Blepharitis
Quelle:
https://www.google.ch/search?q=seborrheic+blepharitis&biw=1301&bih=620&source=lnms&tbm=isch&sa=X&sqi=2&ved=0ah
UKEwj2gv-g3eXOAhWHWhQKHVXUDSMQ_AUIBigB#imgrc=m1T_nfRBWy_KpM%3A
Chalazion
• Localized lipogranulomatous inflammation involving either the meibomian
or zeiss glands
• Nodules develop slowly and are painless, overlying skin is erythmatous
• Lesion disappears in weeks to months, a small amount of scar tissue may
remain
• Occasionally blurred vision secondary to astigmatism induced by chalazion
• CAVE: Basal cell, squamous cell, sebaceous cell carcinoma can masquerade
as chalazia -> histopathologic examination of atypical chalazia
• Management: hot compresses, expression of the meibomian gland,
intralesional injection of a corticosteroid, incision or drainage
Chalazion
Quelle:https://www.google.ch/search?q=chalazion&biw=1301&bih=620&source=lnms&tbm=isch&sa=X&sqi=2&ved=0ahUKEwiZur
mB3uXOAhVEPRQKHUnZDJ8Q_AUIBigB#imgrc=av_Dl0kWQoOj_M%3A
Sarcoidosis
• Multisystem disorder characterized by the development of noncaseating
granulomatous inflammation in affected tissues
• Etiolgy seems to be linked to a genetically predetermined enhacement of
cellular immune responses to a limited number of microbial pathogens
• Ocular involvement in up to 50% affected patients: nodules in the eyelid
skin and canthal region, conjunctival granulomas, calcific band keratopathy,
enlargement of the lacrimal and salivary glands (->KCS), iridocyclitis,
uveitis, periphlebitis, chronic cystoid macular edema, exudative retinal
detachment, granulomatous involvement of the optic nerve
• Management: in case of an isolated anterior uveitis topical corticosteroids.
In all other cases systemic therapy with prednisolon or immunsupression
with methotrexat, azathioprin or infiximab
Ichthyosis
• Represents a diverse group of hereditary skin disorders characterized
by excesively dry skin and accumulation of scale
• Most important forms: Ichthyosis vulgaris, an autosomal dominant
trait, and the X-linked ichthyosis
• Ocular signs: Eylelid scaling, cicatricial ectropion, conjunctival
thickening, corneal changes such as opacities, nodular degenerations,
vascularization, scarring and band keratopathy
• Treatment: hydrating the skin and eyelids, removing scale, and
slowing the turnover of epidermis when approciate
Ichthyosis
Dry, hard and scaly skin.
Quelle: http://skinawareness.org/tag/ichthyosis/
Ectodermal Dysplasia
• Hereditary condition that displays variable defects in the
morphogenesis of ectodermal structures, including hair, skin, nails,
and teeth
• Component in at least 150 distinct hereditary syndromes
• Ocular abnormalities: sparse lashes and brows, blepharitis,
ankyloblepharon, hypoplastic lacrimal ducts, diminished tear
production, abnormal meibomian glands, dry conjunctivae, pterygia,
corneal scarring and neovascularisation, cataract, and glaucoma.
Changes may be due to limbal stem cell deficiency
Ectodermal Dysplasia
Peg shaped teeth, coarse,
sparse hair
Quelle:
https://upload.wikimedia.org/wikipedia/commons/thumb/
d/d5/Ectodermal_dysplasia.jpg/280pxEctodermal_dysplasia.jpg
Xeroderma pigmentosum
• Recessively transmitted disease characterized by impaired ability to
repair sunligt-induced damage to DNA -> skin develops areas of focal
hyperpigmentation, atrophy, actinic keratosis, and telangiectasia,
cutaneous neoplasms
• Ophthalmic manifestations: Conjunctiva with telangiectasia and
hyperpigmentation, pingueculae, pterygia, corneal complications with
exposure keratitis, ulceration, neovascularization, scarring,
perforation, ocular neoplasms, eyelids with atrophy, madarosis,
trichiasis, scarring, symblepharon, entropion, ectropion
Xeroderma pigmentosum
Pigmented and dry skin
Quelle: http://scotdir.com/wp-content/uploads/picdir/xerodermapigmentosum_2.jpg
Noninflammantory Vascular Anomalies of the
Conjunctiva
• Causes of conjunctival hyperemia
- Inflammation: infection, allergy, toxicity, neoplasia
- Direct irritation: foreign body, aberrant eyelashes
- Reflex response: eyestrain, emotional weeping
- Systemic or topical vasodilators: alcohol, oxygen, carcinoid tumor
- Autonomic dysfunction: sympathetic paresis, sphenopalatine ganglion
syndrome
- Vascular engorgement: venous obstruction, hyperviscosity
Herediatary Hemorrhagic Teleangiectasia
• Dominant inherited (but occasionally sporadic) disease with
spontaneous hemorrhage from telangiectatic vessels of the skin,
nasal and oral mucous membranes, gastrointestinal tract, lungs, and
brain
• Conjunctival telangiectasias typically involve the palpebral region
• Conjunctival bleeding in most instances can be controlled with local
pressure
Quelle: http://clinicalgate.com/wp-content/uploads/2015/03/u04-07-9781455776443.jpg
Lymphangiectasia
• Developmental anomaly or in association with trauma or
inflammation
• Irregularly dilated, periodically hemorrhage-filled lymphatic channely
of the bulbarconjunctiva
• Treatment is local excision or diathermy
• Must be distinguished from ataxia-telangiectasia (Louis-Bar
syndrome), in which the epibulbar and interpalpebral telangiectasia
of the arteries lacks an associated lymphatic component
Lymphangiectasia
Quelle: http://www.angelarteaga.es/en/imagenes/procesos/tumor_image008.jpg
Vitamin A Deficiency
• Vitamin A is an essential fat-soluble vitamin
• Results from low diatary intake or decreased absorption
• Leads to xerosis (dryness of the conjunctiva and cornea), nyctalopia (night
blindness), xerophthalmia
• Xerophthalmia responsible for at least 20.000 – 100.000 new cases of blindness
worldwide each year.
• Systemic vitamin A deficiency, best characterized by keratomalacia, is a medical
emergency with an untreated mortality rate of 50%
• Ocular manifestation: xerosis, metaplastic keratinization of the conjunctiva (Bitot
spots), corneal ulcers and scars, diffuse corneal necrosis (keratomalacia)
• Vitamin and protein-calorie supplements, adequate corneal lubrication and
prevention of secondary infection
Corneal xerosis
Drying of the cornea
Quelle: http://www.cehjournal.org/wp-content/uploads/fig3-corneal-xerosis.jpg
Vit. C Deficiency
• Essential vitamin for humans, we lack its synthetic enzyme, Lgulonolactone oxidase
• Cofactor in the hydroxylation of lysine and proline in ribosomal
collagen synthesis
• Deficiency results in unstable collagen fiber formation
• In scurvy xerosis and impaired wound healing possible
Exposure Keratopathy
Results from any disease process that limits eyelid closure:
Neurogenic diseases such as seventh nerve palsy
Degenerative neurologic conditions such as Parkinson disease
Cicatricial or restrictive eyelid diseases such as ectropion
Drug abuse
Blepharoplasty
Skin disorders such as Stevens-Johnson syndrome or xeroderma pigmentosum
Ocular signs: punctate epithelial keratopathy usually involves the inferior third of
the cornea. Epithelial defects, may lead to ulceration, melting, and perforation
- Therapy similar to that for severe dry eye
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Seventh nerve palsy with lagophthalmus
Quelle: http://www.eyecasualty.co.uk/maincontent1/Rh1.jpg
Floppy Eyelid Syndrome
• Patients with a flimsy, lax upper tarsus that everts with minimal
upward force applied to the upper lid -> contact with the pillow
during sleep
• Clinical findings: papillae on the upper palpebral conjunctiva, mucus
discharge, corneal involvement (punctate epithliopathy, superficial
vascularisation, keratoconus)
• Treatment: Shield or taping eyelids closed at night or performing
surgical eyelid-thightening procedures
Floppy Eyelid Syndrome
Quelle: http://www.mrcophth.com/oculoplasticgallery/floppyeyelidsyndrom/floppyeyelid3.jpg
Superior Limbic Keratokonjunktivitis
• Thought to result from mechanical trauma transmitted from the upper
eyelid to the superior bulbar and tarsal conjunctiva. Association with
autoimmune thyroid disease
• Typically develops in adult women 20-70 years of age
• Condition usually resolves spontaneously
• Ocular findings: often bilateral, injection and thickening of the superior
bulbar conjunctiva, hypertrophy of the superior limbus, superior corneal
filamentary keratopathy
• Treatment: topical anti-inflammatory agents, large-diameter bandage
contact lenses, superior punctal occlusion, thermocauterization of the
superior bulbar conjunctiva, resection of the bulbar conjunctiva superior to
the limbus, topical ciclosporine, autologous serum eyedrops, and
conjunctival fixation sutures
Superior Limbic Keratokonjunctivitis
SLK with hypertrophy of the superior limbus, injection
and thickening of the superior bulbar conjunctiva.
Quelle. http://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/Superior-limbic-keratoconjunctivitis-SLK/SLKLRG.jpg
Recurrent Corneal Erosion
• Typically in eyes that have suffered a sudden, sharp, abrading injury
or in patients with preexisting epithelial basement membrane
dystrophy
• Episodes usually last from 30 minutes to several hours
• Slit lamp examination: subtle corneal abnormalities, epithelium loosly
attached, heaped up, edematous, with pooling of fluorescein over the
affected area
• Management: frequent lubrication, cycloplegia, 5% NaCl, therapeutic
CL, epithelial debridement, anterior stromal micropunction,
phototherapeutic keratectomy
Persistent Corneal Epitelial Defect
Common causes
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Herpetic corneal disease
Delayed postsurgical epithelial healing
Chemical burns
Toxicity from topically applied medications
Recurrent corneal erosiones
Dry-eye syndromes
Infections
Neuroparalytic keratopathy
Neurotrophic keratopathy
Anterior segment necrosis
Ocular signs and treatment
• Characterized by central or paracentral areas of chronic nonhealing
epithelium that resists maximal therapeutic endeavors
• Epithelial defects with elevated, rounded edges, sometimes with
stromal infiltration and corneal anesthesia. Can progress to
vascularization, corneal opacification, scarring, necrosis and thinning
of the stroma, perforation
• Management: Treatment of the underlying disease, use of the full
spectrum of approaches for dry eye and exposure keratopathy
Neurotrophic keratopathy
• Results from damage to CN V, which causes corneal hypoesthesia
• Damage caused by: surgical trauma (ablation of the trigeminal ganglion,
PK, large limbal incisions, LASIK) cerebrovascular accidents, aneurysms,
multiple sclerosis, tumors (acoustic neuroma, neurofibroma, angioma),
herpes zoster ophthalmicus, herpes simplex keratitis, Hansen disease
(Lepra), toxicity of topical medications (anesthetics, carbonic anhydrase
inhibitors, NSAIDs, β-blockers), diabetes mellitus, hereditary sensory
neuropathy, familial dysautonomia (Riley-Day syndrome)
• Involves the central or inferior paracentral cornea
• Ocular signs include recurrent epithelial defects, ulcers, perforation
• Management: treatment of the underlying disease, use of the full spectrum
of approaches for dry eye and exposure keratopathy
Trichiasis und Distichiasis
• Trichiasis: eyelashes emerging from their normal anterior origin are
curved inward the cornea
• Idiopathic oder secondary to chronic inflammatory conditions, most
probably the result of subtle cicatrical entropion of the eyelid margin
• Distichiasis: congenital or acquired condition in which an extra row of
eyelashes emerges from the ducts of meibomian glands
• Aberrant eyelashes (eg. by epilation, electrolysis, cryotherapy) and
poor eyelid position should be corrected
Trichiasis
Quelle: https://opto.ca/sites/default/files/trichiasis_8489112576_70ca9b7a19_o.jpg
Distichiasis
Quelle: http://img.medscapestatic.com/pi/meds/ckb/65/30765tn.jpg
Mucus-fishing syndrome
• Increased mucus production as a response to ocular surface damage,
typically in KCS
• Compulsive removal of the mucus strands from the fornix heightens
the ocular surface irritation, which stimulates additional mucus
production -> vicious circle
• Characterized by a well-circumscribed pattern of rose bengal or
lissamine green staining on the nasal and inferior bulbar conjunctiva
Mucus-fishing Syndrome
Patient "fishing" mucus.
Quelle:
https://i.ytimg.com/vi/AH9zKG66avI/hqdefault.jpg
Dellen
• Saucerlike depressions of the cornea
• Desiccation of the epithelium and subepithelial tissues occurs at or
near the limbus adjacent to elevations such as pterygia, filtration
blebs, dermoids
• Tear-film interrupted by these surface elevations
• Treatment with frequent ocular lubrication or pressure patching
Dellen
Quelle: http://www.rootatlas.com/wordpress/wp-content/uploads/2007/08/dellencornea.jpg
Metabolic epithelial damage
• Due to contact lens overwear
• Microcystic epitheliopathy most commonly in patients using
extended-wear soft contact lenses
• Ocular signs include central epithelial edema, epithelial erosiones,
frank ulceration, acute epithelial necrosis
Toxic conjunctivitis
• Proteolytic enzymes and chemicals used for cleaning contact lenses
(BAC, chlorhexidine, hydrogen peroxide) can cause conjunctival
injection, epithelial staining, punctate epithelial keratopathy, erosions
and microcysts
Allergic conjunctivitis
• Hypersensitivity reaction to the preservative thimerosal in contact
lens solutions
• Declined in prevalence as a result of the replacement by other
preservatives
• Ocular signs include injection of the superior bulbar conjunctiva,
epitheliopathy of the cornea and conjunctiva, papillary conjunctivitis,
superficial pannus
Neovascularization
• Neovascular ingrowth into the peripheral cornea (micropannus)
common in soft lens wearers
• CL should be discontinued if the neovascularization extends further
than 2mm into the cornea
• Probably caused by hypoxia and chronic trauma to the limbus
• Deep stromal neovascularization associated with extended-wear
contact lenses, especially in aphakia, symptomatic when secondary
lipid deposition appears
Pannus
Small pannus extending onto
the superior corneal surface.
http://webeye.ophth.uiowa.edu/eyeforum/cases-i/Case77/OcularRosacea-Blurry-Red-Itchy_2B.jpg
Limbal Stem Cell Deficiency
• Epithelial cells of the ocular surface are permanently renewed through
proliferation of stem cells
• Corneal stem cells located in the basal cell layer of the limbus, conjunctival
stem cells distributed throughout bulbar surface and fornices
• 25-33% of the limbus must be intact to ensure normal ocular resurfacing
• In case of stem cell deficiency corneal neovascularisation,
conjunktivalisation of the cornea, irregular ocular surface, disturbed
epithelial wound healing, recurrent ulcers
• Evaluation with impression cytology (corneal surface with the presence of
goblet cells and conjunctival epithelium)
Etiologic Classification of Limbal Stem cell
Deficiency
Idiopathic
Trauma (Chemical/thermal burns)
Iatrogenic (Surgery, radiation, contact lens use, local chemotherapy)
Systemic (Medications, Graft-vs-host disease)
Autoimmune (Stevens-Johnson syndrome, ocular cicatrical pemphigoid)
Eye disease (Neoplasia und degeneration, neurotrophic keratitis, infections,
atopy, peripheral corneal ulcers, anterior segment ischemic syndrome)
• Congenital und hereditary (z.B. aniridia, multiple endocrine neoplasia,
Xerorderma pigmentosa)
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•
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•
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Managment
• Limbal transplantation from the ipsilateral eye or from an HLAmatched living related donor with a subsequent immune supression
Limball Stem Cell Deficiency
Ocular surface failure with neovaskularization and
opacification due to an alkali burn
Quelle:
http://www.stembook.org/sites/default/files/pubnode/06ab13370d5294906af8f5609d71afc80e09f474/Limbal_e
pithelial_stem_cells_of_the_cornea/Secker05.jpg
Take home message
• Dry eye syndrome is a very common disease and needs a systematic
approach and good patient education for successful therapy
• Recurrent erosion syndrome is often misdiagnosed as dry eye
syndrome and not properly treated, detailled history and concise
slitlamp exam is important
• Increasing number of contact lens wearers and improper wearing
habits are causing more and more contact lens associated problems
(infections, hypoxia, exposure to preservatives) that need proper
management