Exogen bedingte Retinopathien

Zusammenfassung

Exogen bedingte Retinopathien werden am häufigsten durch externe Stimulanzien, seltener durch unerwünschte Arzneimittelwirkungen systemisch oder intravitreal eingesetzter Medikamente und noch seltener durch Impfungen oder die Einwirkung von Lichtstrahlung verursacht. Die Kenntnis exogener Ursachen und ihre mögliche Symptomatik ist zur Prophylaxe oder zur Früherkennung schädigender Wirkungen und zur adäquaten Beratung der Patienten wichtig.

Abstract

Exogenously induced retinopathies can be caused by consumation of stimulating substances, systemic or ocular medications, vaccinations, light or irradiation. Some of the effects are transient, whereas other effects induce irreversible toxic reactions. Retinal damage may develop either acutely with obvious relation to the damaging cause, but often may take a long duration of repeated use of a substance or medication. External stimulants (e.g. nicotine, alcohol, poppers, methanol) are the most frequent cause of exogenously induced retinal damage. Side effects from systemic drugs (e.g. hydroxychloroquine, ethambutol, MEK-, ERK-, FLT3-, checkpoint inhibitors, didanosin, pentosanpolysulfat sodium) or intravitreally applied drugs (e.g. antibiotics, VEGF-inhibitors) are less frequent. Ocular side effects associated with vaccinations are rare. Ambient light sources induce no damaging effects on the retina. Incorrect use of technical or medical light sources (e.g. laser pointers) without adherence to safety recommendations or unshielded observation of the sun might induce permanent retinal damage. Local or external irradiation might induce retinal vascular damage resulting in radiation retinopathy.

Kernaussagen

• Exogen bedingte retinale Erkrankungen können durch exogen zugeführte Substanzen oder Strahlung im sichtbaren oder nicht sichtbaren Wellenlängenbereich induziert werden.

• Exogen zugeführte Substanzen können vorübergehende reversible Veränderungen auslösen oder über toxische, autoimmune oder mechanische Wirkungen permanente Schäden verursachen.

• Toxische Langzeitwirkungen werden am häufigsten durch externe Stimulanzien (Nikotin, Alkohol) verursacht.

• Unerwünschte Arzneimittelwirkungen (UAW) von systemisch angewandten Medikamenten an der Netzhaut sind selten. Wegen der breiten Anwendung sind retinale Veränderungen bei der Langzeittherapie mit (Hydroxy-)Chloroquin im klinischen Alltag wahrscheinlich am häufigsten. Screening-Untersuchungen sind nur bei wenigen Medikamenten sinnvoll. Das Auftreten von UAW erfordert eine Therapieänderung in Abstimmung mit den behandelnden Ärzten.

• Die intraokulare Anwendung von Medikamenten (Antibiotika, Anti-VEGF-Medikamente) kann ebenfalls zu ausgeprägten Funktionsstörungen führen.

• Bei Verdacht auf UAW dient eine Online-Meldung (https://humanweb.pei.de) der Sicherheit der Pharmakotherapie.

• Retinale Veränderungen nach Impfungen sind extrem selten.

• Retinale Schäden durch Licht treten nur durch unsachgemäße Handhabung technischer oder medizinischer Geräte sowie ungeschützter Betrachtung der Sonne auf.

• Strahlenbedingte Schäden der Netzhaut führen zu vaskulären Veränderungen.

Schlüsselwörter

Retina - Toxizität - unerwünschte Arzneimittelwirkungen - Impfungen - Lichtschaden

Key words

retina - toxicity - medical side effects - vaccinations - light damage

Publication History

Article published online:
17 November 2022

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