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Das trockene Auge als komplexe Fehlregulation der funktionellen Anatomie der Augenoberfläche

Neue Impulse zum Verständnis des trockenen Auges

  • Leitthema
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Zusammenfassung

Hintergrund

Das trockene Auge ist eine Störung des Tränenfilms, die zu Epithelschäden und einer Veränderung der normalen Homöostase an der Augenoberfläche führt.

Methoden

Es wurde ein Review der Literatur durchgeführt, um verschiedene Konzepte zum Verständnis des trockenen Auges zu vergleichen und mit einem Fokus auf Mechanismen der integrierenden funktionellen Anatomie der Augenoberfläche.

Ergebnisse

Das Verständnis der Pathogenese des trockenen Auges hat sich entwickelt von der alleinigen Erkenntnis eines zugrunde liegenden Tränenmangels über die Betrachtung der Tränenqualität bis zum Konzept der Benetzbarkeit der Augenoberfläche. Allerdings tragen zahlreiche weitere Aspekte wie die Differenzierung des Oberflächenepithels, Innervation, Hormonstatus oder Immunprotektion zur intakten funktionellen Anatomie der Augenoberfläche bei. Es mehren sich Hinweise, dass immunologisch gesteuerte Entzündungsvorgänge einen wichtigen primären oder sekundären pathogenetischen Faktor darstellen. Dies kann vermutlich durch die Zellen des physiologischen Schleimhautimmunsystems (Augen-assoziiertes lymphatisches Gewebe, EALT) reguliert werden. Androgene sind ein wichtiger trophischer Faktor für die Integrität der Augenoberfläche, und ihr Mangel prädisponiert zur Entwicklung von Entzündungen.

Schlussfolgerung

Das trockene Auge repräsentiert eine komplexe Fehlregulation der funktionellen Anatomie der Augenoberfläche, die von verschiedenen Ursachen ausgehen kann. Eine entstehende immunregulierte Entzündung kann diese Pathomechanismen verknüpfen und im Sinne eines Circulus vitiosus negativ verstärken.

Abstract

Introduction

Dry eye disease is a disorder of the tear film that results in epithelial damage and in a disruption of the normal homeostasis at the ocular surface. It is widespread and causes symptoms ranging from discomfort to blindness.

Methods

A review of the existing literature was used to compare different past and recent concepts for the understanding of dry eye disease with a focus on aspects of the integrating functional anatomy of the ocular surface.

Results

The understanding of the pathogenesis of dry eye disease has proceeded from the mere recognition of a lack of tears to a consideration of their quality and to the concept of wetting of the ocular surface. However, several other aspects as epithelial differentiation, innervation, hormonal status or immune protection contribute to the intact functional anatomy of the ocular surface. Recently it has been recognized that immunologically regulated mechanisms of inflammation represent a primary or secondary pathogenetic factor for dry eye disease. This is conceivably regulated by the cells of the physiological mucosal immune defence system, the eye-associated lymphoid tissue (EALT). Androgens represent an important trophic factor for the ocular surface and their deficiency predisposes to inflammation.

Conclusion

Dry eye disease represents a complex dysregulation of the functional anatomy of the ocular surface that can start from different alterations (e.g. insufficient secretion, defects in wetting or innervation). Immune-based inflammation is able to interconnect and negatively reinforce these different pathomechanisms, resulting in a vicious circle.

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  1. Abteilung für Zellbiologie in der Anatomie, Medizinische Hochschule Hannover

    E. Knop & N. Knop

  2. Klinik für Augenheilkunde, Medizinische Hochschule Hannover, Hannover

    H. Brewitt

  3. Augenklinik-Forschungslabor, Charite-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Str. 1, 13353 , Berlin

    E. Knop

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Knop, E., Knop, N. & Brewitt, H. Das trockene Auge als komplexe Fehlregulation der funktionellen Anatomie der Augenoberfläche. Ophthalmologe 100, 917–928 (2003). https://doi.org/10.1007/s00347-003-0935-7

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