Differenzierte Therapie der Keratokonjunctivitis sicca beim Sjögren-Syndrom

Zusammenfassung

Die Keratokonjunctivitis sicca bei Sjögren-Syndrom ist eine Erkrankung, die zu stark beeinträchtigenden Symptomen sowie zu Hornhautkomplikationen verbunden mit Visusverlust führen kann. Neben entzündlichen Faktoren werden hormonelle Veränderungen sowie neuronale Störungen in der Pathogenese diskutiert. Die Therapie besteht unter anderem aus symptomatischen Maßnahmen (Schutzbrillen, Luftbefeuchter), Beseitigung von Lidanomalien und Refraktionsfehlern, Behandlung einer assoziierten Blepharitis sowie im Absetzen bestimmter Medikamente. Neben einer Vielzahl von Tränenersatzprodukten und autologem Serum stehen heute im Ansatz kausale Medikamente zur Verfügung, wie lokale Kortikosteroide, topisches Ciclosporin A und orale (M1)/M3-Agonisten. Lokale Androgene und Sekretagoga wie Diquafosol-Tetrasodium und 15(S)-HETE zur Therapie des Trockenen Auges sind in klinischer Erprobung.

Abstract

Keratoconjunctivitis sicca in patients with Sjögren’s syndrome is typically associated with severe subjective symptoms and may lead to corneal complications and visual loss. Inflammation, hormonal factors and neuronal dysregulations are discussed as pathogenetic factors. Therapy includes safety goggles, humidifiers, correction of lid anomalies and refraction deficits, treatment of associated blepharitis and discontinuance of specific medications. Besides numerous artificial tears solutions and autologous serum, treatments became available with topical steroids, cyclosporin A and oral muscarinic agonists that target the basic disease mechanisms. Topical androgens and secretagogues such as diquafosol tetrasodium and 15(S)-HETE are in clinical evaluation for the treatment of keratoconjunctivitis sicca.

Keratokonjunctivitis sicca - Sjögren-Syndrom - kausale Medikamente

Keratoconjunctivitis sicca - Sjögren’s syndrome - treatments targeting basic disease mechanisms

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