Augenverätzungen.

Chemical burns of the ocular surface (CBOS) are emergencies of highest urgency. Therefore, an adequate emergency care is mandatory. Following a precise analysis of the initial damage, a staged therapeutic approach is used to prevent persistent impairment of the ocular surface. In the acute stage, the prevention of complications is targeted (symblepharon, conjunctival scarring, lacrimal stenosis, corneal ulceration, intraocular inflammation, elevated intraocular pressure, etc.). In later stages, if complications have developed, a secondary restoration of the ocular surface is focussed. Sometimes this requires several surgical interventions. Based on a review of international literature, this review highlights the pathophysiology according to different chemical agents, CBOS stages as well as main therapy strategies in early and advanced stages of CBOS. Acute treatment aims to lower inflammation, oxidative stress and tries to promote reepithelialisation. Besides conjunctival scarring, loss of goblet cells and corneal opacification a limbal stem cell insufficiency is the most harming complication. Several new techniques have been developed to recover the ocular surface with a sufficient and clear epithelial layer in order to avoid neovascularization of the cornea. The knowledge concerning the high risk potential for persistent visual impairment in CBOS patients and the ability for appropriate emergency care should be kept in every physician's mind dealing with CBOS.

Pressure-Lowering Effect of Interventional Fistula Occlusion in Secondary Glaucoma due to Orbital Draining Intracerebral Fistulae. / Drucksenkender Effekt der interventionellen Fistelokklusion bei Sekundärglaukom infolge orbital drainierender intrazerebraler Fisteln.

BACKGROUND: Carotid cavernous sinus fistulas (CSCF) are pathological connections of the internal and/or external carotid artery (and/or its branches) to the cavernous sinus. Ophthalmological symptoms and problems occur particularly when drainage is via the superior ophthalmic vein. MATERIAL AND METHODS: Seven eyes of six patients with a high-grade suspicion of CSCF were included in this retrospective monocentric study. Digital subtraction angiography (DSA) was performed in the included patients, where an interventional fistula closure was performed in the case of CSCF. Four of the six patients received a pre- and post-interventional day-night intraocular pressure profile. Furthermore, medical history, symptoms, visual acuity, slit lamp microscopic findings, and DSA findings were evaluated. RESULTS: The most common symptoms reported by patients were red eyes, diplopia, and exophthalmos. When the intraocular pressure (IOP) was measured, 83.33% of the patients showed increased values. The mean IOP in the day-night intraocular pressure profile in the affected eye before intervention was 23.5 (± 2.7) mmHg compared to 14.1 (± 2.3) mmHg in the healthy eye. A significant difference could thus be demonstrated in side comparison (p = 0.0047). The post-interventional measurement showed a mean IOP of 15.3 (± 1.0) mmHg in the affected eye and thus a significant difference to the pre-interventional measurement in the affected eye (p = 0.0018). Four of the six patients with CSCF were taking antiglaucomatous eye drops before the intervention, and two patients after the intervention. The number of antiglaucoma drugs used could also be reduced. CONCLUSION: Interventional fistula closure is an effective method for treating the secondary increase of IOP in CSCF. Successful closure of the fistula showed a significant reduction in IOP, which was not possible with the sole administration of antiglaucoma drugs. Radius-Maumenee syndrome should be considered as a differential diagnosis.

Transcutaneous (External) Dacryocystorhinostomy with Reconstruction of the Ductus nasolacrimalis. / Transkutane (externe) Dakryozystorhinostomie mit Rekonstruktion des Ductus nasolacrimalis.

BACKGROUND: Dacryocystorhinostomy (DCR) is regarded as the gold standard for the treatment of chronic dacryocystitis (CDC). Different modifications of the surgical procedure have been developed over the years. METHODS: Patients with CDC due to postsaccal lacrimal stenosis and under treatment with DCR have been included in this retrospective study. Two groups of different surgical procedures were analysed: firstly DCR without reconstruction of the ductus nasolacrimalis (DNL, group 1) and secondly patients with reopening the DNL (group 2). Criteria for success were absence of permanent epiphora, absence of inflammation of the lacrimal sac (functional success), and no recurrent surgery with free patency of the lacrimal duct (anatomical success). This was obtained by questionnaire after a follow-up of at least 12 months. The impact of gender, ectasia of the lacrimal sac, dacryoliths, and prior lacrimal surgeries was analysed. RESULTS: Overall, 248 surgeries were enrolled in this trial. Mean age in group 1 was 68 years (range: 22 to 92 years) and gender ratio was 3.2 to 1 (female : male). In that group, 68 operations could be followed up. In group 2, 62 operations on patients of a mean age of 63 years (range: 24 to 89 years) and a gender ratio of 2.9 to 1 (female : male) were observed. Complete success occurred in 75.0% in group 1 and 75.8% in group 2. Recurrent operations were necessary in one case of group 2 (1.6%) and 4 cases of group 1 (5.9%). Gender (group 1 p = 1; group 2 p = 0.115; between groups p = 0.511), ectasia of the lacrimal sac (group 1 p = 0.877; group 2 p = 0.674; between groups p = 0.878), dacryolith (group 1 p = 1; group 2 p = 0.465; between groups p = 1), and prior lacrimal surgery (group 1 p = 0.092; group 2 p = 0.051; between groups p = 0.520) did not influence the success rates in each group or between groups. Significantly more dacryoliths were found during operations of group 2 (p = 0.010). CONCLUSION: Reconstruction of the DNL during DCR is a possible and easy modification, with a slightly better success rate in curing CDC. Intraoperatively, dacryoliths might not be apparent remain in the deeper parts of the lacrimal ducts. Therefore, these segments should be inspected during surgery.

[Concrements of the lacrimal apparatus]. / Konkremente des Tränenapparates.

Concrements of the lacrimal apparatus, known as dacryoliths, can occur at different localizations and can cause a variety of symptoms. A common clinical sign is chronic inflammation, possibly exhibiting acute exacerbation. Based on a literature review and descriptive clinical cases with histopathological correlations, this contribution summarises the most important information concerning epidemiology, aetiopathogenesis, composition, histology, and therapy of lacrimal concrements. Furthermore, factors known to affect lacrimal lithogenesis are addressed. Concrements of the lacrimal gland cause a swelling at the lateral canthus. With only mild pain, this manifests as circumscribed conjunctival hyperaemia. Histologically, the gland tissue is characterised by acute-erosive to chronic inflammation. The concrements consist of amorphic material. Inflammatory infiltration is dominated by neutrophil granulocytes. Canalicular concrements are highly correlated with chronic canaliculitis. Besides epiphora, patients present with purulent discharge at the affected canaliculus. Actinomyces are frequently found inside these deposits and form drusen-like formations. The surrounding tissue reacts with plasma-cellular and granulocytic inflammation. Dacryoliths (concrements of the lacrimal sac) are associated with dacryocystitis, whereby acute and chronic types are common. Stones can be found in up to 18% of patients undergoing dacryocystorhinostomy or dacryoendoscopy. Preoperative diagnostic testing is challenging, as many lacrimal sac stones cannot be reliably visualised by diagnostic procedures. Recurring episodes of epiphora, mucopurulent discharge, and dacryocystitis are common indicators of dacryoliths. Lacrimal syringing is often possible and shows that total blockage is not present. Histology of the lacrimal mucosa reveals lymphocytic infiltration and submucosal fibrosis. The immediate vicinity of the dacryoliths shows acute inflammation. Therapy consists of stone extraction and improving lacrimal drainage, as the latter is recognised as the main risk factor for dacryolith formation.

Concrements of the Lacrimal Apparatus. / Konkremente des Tränenapparates.

Concrements of the lacrimal apparatus, known as dacryoliths, can occur at different localizations and can cause a variety of symptoms. A common clinical sign is chronic inflammation, possibly exhibiting acute exacerbation. Based on a literature review and descriptive clinical cases with histopathological correlations, this contribution summarises the most important information concerning epidemiology, aetiopathogenesis, composition, histology, and therapy of lacrimal concrements. Furthermore, factors known to affect lacrimal lithogenesis are addressed. Concrements of the lacrimal gland cause a swelling at the lateral canthus. With only mild pain, this manifests as circumscribed conjunctival hyperaemia. Histologically, the gland tissue is characterised by acute-erosive to chronic inflammation. The concrements consist of amorphic material. Inflammatory infiltration is dominated by neutrophil granulocytes. Canalicular concrements are highly correlated with chronic canaliculitis. Besides epiphora, patients present with purulent discharge at the affected canaliculus. Actinomyces are frequently found inside these deposits and form drusen-like formations. The surrounding tissue reacts with plasma-cellular and granulocytic inflammation. Dacryoliths (concrements of the lacrimal sac) are associated with dacryocystitis, whereby acute and chronic types are common. Stones can be found in up to 18% of patients undergoing dacryocystorhinostomy or dacryoendoscopy. Preoperative diagnostic testing is challenging, as many lacrimal sac stones cannot be reliably visualised by diagnostic procedures. Recurring episodes of epiphora, mucopurulent discharge, and dacryocystitis are common indicators of dacryoliths. Lacrimal syringing is often possible and shows that total blockage is not present. Histology of the lacrimal mucosa reveals lymphocytic infiltration and submucosal fibrosis. The immediate vicinity of the dacryoliths shows acute inflammation. Therapy consists of stone extraction and improving lacrimal drainage, as the latter is recognised as the main risk factor for dacryolith formation.

Impact of the transcription factor IRF8 on limbal epithelial progenitor cells in a mouse model.

The limbus of the eye is the location of the corneal epithelial stem cell niche. These cells are necessary for continuous renewal of the corneal epithelium. In the case of limbal stem cell deficiency, these cells are damaged, and the whole cornea becomes opaque. It is important to be able to identify stem cells that could be applied for new therapeutic strategies. There are various known markers to characterize these cells, including p63, Nanog, oct4 and FGFR2. However, none of these markers are exclusively expressed in these stem cells (they are also expressed in transient amplified cells). It seems likely that a combination of stem cell markers will be necessary for corneal stem cell identification. The aim of this study was to detect IRF8 in limbal epithelial stem cells and to determine its function. In a mouse model, IRF8 could be detected in limbal and basal epithelial cells of the cornea by histological and immunohistological staining of wild-type mouse eyes. Furthermore, the limbus of the eye was significantly smaller in IRF8-knockout mice than in wild-type mice, and the expression of Nanog was lower in IRF8-knockout mice. This suggests that IRF8 has an influence on the maintenance of stem cell properties in the limbus, possibly by affecting the expression of Nanog. Furthermore, IRF8 has an impact on E-cadherin and N-cadherin expression in the mouse eye.

Posttraumatic Ocular Hypotony Through Epithelial Downgrowth. / Posttraumatische Bulbushypotonie durch Epithelinvasion.

BACKGROUND: Intraocular epithelial downgrowth is a rare but potentially devastating posttraumatic complication. If left untreated, this may result in corneal decompensation, secondary angle-closure glaucoma, retinal detachment and blindness. PATIENT AND METHOD: A 10-year-old patient with penetrating globe injury and delayed wound management elsewhere presented with corneal melting and decompensation, retinal detachment and ocular hypotony. Following penetrating keratoplasty, cyclopexy and vitrectomy, corneal melting in the interface with renewed retinal detachment was noted within days. The hopeless prognosis required enucleation of the globe. RESULTS: Optical coherence tomography revealed not only corneal melting, but also markedly hyperreflective structures posterior to the cornea. Immunohistology demonstrated diffuse multi-layered nonkeratinised squamous cell epithelium on the posterior corneal surface, iris, ciliary bodies, and retina, as well as below the choroid, with renewed tractional retinal detachment. CONCLUSION: Posttraumatic epithelial downgrowth may result in tractional retinal detachment, cyclodialysis cleft and/or corneal melting. Hyperreflective membrane deposits on OCT may be indicative of diffuse epithelial downgrowth. Especially in children, prompt wound closure in globe injuries is vital to avoid this serious posttraumatic complication.

[Deep periocular trauma with affection of the lacrimal ducts during Caesarean section]. / Tiefes periokuläres Trauma mit Tränenwegsbeteiligung durch Kaiserschnittentbindung.

Periocular injuries during a caesarean section are extremely rare. The case report of a five hour old newborn addresses the trauma management concerning diagnostics, therapy, and post-operative care of a deep periocular soft tissue injury. The pattern of injury consisted of full thickness wounds of the medial and lateral lid margins, opening of the superior conjunctival fornix, and penetration of Tenon's capsule. The reconstruction was performed layer by layer while an autostable monocanaliculonasal lacrimal intubation was inserted.

ALT (allogeneic limbal transplantation): a new surgical technique for limbal stem cell deficiency.

PURPOSE: Limbal stem cell deficiency (LSCD) is a rare but extremely relevant disease of the eye. LSCD patients often require a variety of surgical procedures, including keratoplasty in some cases. However, the outcome of these surgeries, including opacification and revascularization, is often frustrating due to LSCD relapse. METHODS: We developed a new surgical technique for the treatment of LSCD in which partial allogenic limbal transplantation (ALT) is carried out as part of penetrating keratoplasty (PK). After the PK, 1-8 slices from the limbal tissue of the donor graft are prepared and placed under the double running sutures attaching the corneal graft. This procedure was performed on 14 patients with LSCD, caused by severe ocular burn in 5 cases and by infection in 9. Between one and eight limbal transplants were used depending on the extension of the LSCD. RESULTS: All 14 patients showed stable or increased visual acuity after the ALT surgery compared to their preoperative visual acuity. All of the grafts were integrated into the superficial corneal layers without progression of corneal vascularization beyond the limbal grafts. The median follow-up period was 12 months on average. CONCLUSION: The ALT method seems to be a promising surgical procedure for the treatment of patients with LSCD. It can be properly carried out in the context of keratoplasty and does not require a separate donor tissue. The ALT grafts may offer the possibility of constructing a new limbal region, resulting in stable or even increased visual acuity and the absence of corneal vascularization.

Pathogenic STX3 variants affecting the retinal and intestinal transcripts cause an early-onset severe retinal dystrophy in microvillus inclusion disease subjects.

Biallelic STX3 variants were previously reported in five individuals with the severe congenital enteropathy, microvillus inclusion disease (MVID). Here, we provide a significant extension of the phenotypic spectrum caused by STX3 variants. We report ten individuals of diverse geographic origin with biallelic STX3 loss-of-function variants, identified through exome sequencing, single-nucleotide polymorphism array-based homozygosity mapping, and international collaboration. The evaluated individuals all presented with MVID. Eight individuals also displayed early-onset severe retinal dystrophy, i.e., syndromic-intestinal and retinal-disease. These individuals harbored STX3 variants that affected both the retinal and intestinal STX3 transcripts, whereas STX3 variants affected only the intestinal transcript in individuals with solitary MVID. That STX3 is essential for retinal photoreceptor survival was confirmed by the creation of a rod photoreceptor-specific STX3 knockout mouse model which revealed a time-dependent reduction in the number of rod photoreceptors, thinning of the outer nuclear layer, and the eventual loss of both rod and cone photoreceptors. Together, our results provide a link between STX3 loss-of-function variants and a human retinal dystrophy. Depending on the genomic site of a human loss-of-function STX3 variant, it can cause MVID, the novel intestinal-retinal syndrome reported here or, hypothetically, an isolated retinal dystrophy.

Comparison of Two Conjunctival Incision Techniques in Strabismus Operations: Analysis of the Patient Population in 2008, 2010 - 2014. / Vergleich zweier Schnitttechniken zur Eröffnung der Bindehaut bei Augenmuskeloperationen: Analyse des Krankengutes der Jahre 2008, 2010 ­â€Š2014.

BACKGROUND: Until 2010, the Halle university hospital used the limbal approach in strabismus operations to open the conjunctiva, as first described by Harms in 1949. In 2010, this was changed the to a modified radial incision technique, as inspired by the fornix incision of Harms and the "minimally invasive strabismus surgery" (MISS) technique of D. S. Mojon. The indication is the reduction in complications and protection of the conjunctiva. METHODS: A retrospective analysis was performed of cases between 2008 and March 2014 was performed, including a total of 258 patients. 109 patients were treated with the limbal approach and 149 patients with the radial cut. The following aspects were included for comparison: the medium-term control of the squint angle after three months, intra- and postoperative number of complications, duration of the operations. A survey collected the reasons for not taking part in follow-up checks and the alignment of these patients. To compare binary variables, the chi-square-test was used and to compare average terms the unpaired t test, with a level of significance of 0.05%. RESULTS: The results of the postoperative square angles were comparable to both each other as to the literature. The number of complications was kept low in both techniques. The duration of the operations under the radial incision technique was clearly higher. However, throughout the observed years the duration of operations turned out to have decreased. The reasons for not taking part in controls were diverse and the alignment of these patients was high, regardless of the incision technique. CONCLUSIONS: The limbal approach was a well-proven method to open the conjunctiva. After changing to the radial incision technique, there was never a negative influence on the results of the surgeries or the rate of complications. The duration of the operations was extended. Superiority of the new technique was not shown. It could however be an alternative, as it spares the conjunctiva and permits glaucoma operations.

Survey of Rejection Prophylaxis Following Suture Removal in Penetrating Keratoplasty in Germany. / Umfrage zur Abstoßungsprophylaxe bei Fadenentfernung nach perforierender Keratoplastik in Deutschland.

BACKGROUND: Penetrating keratoplasty (PK) gets more and more reserved to cases of increasing complexity. In such cases, ocular comorbidities may limit graft survival following PK. A major cause for graft failure is endothelial graft rejection. Suture removal is a known risk factor for graft rejection. Nevertheless, there is no evidence-based regimen for rejection prophylaxis following suture removal. Therefore, a survey of rejection prophylaxis was conducted at 7 German keratoplasty centres. OBJECTIVE: The aim of the study was documentation of the variability of medicinal aftercare following suture removal in Germany. METHODS: Seven German keratoplasty centres with the highest numbers for PK were selected. The centres were sent a survey consisting of half-open questions. The centres performed a mean of 140 PK in 2018. The return rate was 100%. The findings were tabulated. RESULTS: All centres perform a double-running cross-stitch suture for standard PK, as well as a treatment for rejection prophylaxis with topical steroids after suture removal. There are differences in intensity (1 - 5 times daily) and tapering (2 - 20 weeks) of the topical steroids following suture removal. Two centres additionally use systemic steroids for a few days. DISCUSSION: Rejection prophylaxis following PK is currently poorly standardised and not evidence-based. All included centres perform medical aftercare following suture removal. It is assumed that different treatment strategies show different cost-benefit ratios. In the face of the diversity, a systematic analysis is required to develop an optimised regimen for all patients.

[Primary Reconstruction of Lacrimal Ducts after Trauma - Bicanaliculonasal Intubation Using Autostable Tubes]. / Primäre Rekonstruktion der ableitenden Tränenwege nach Trauma ­ bikanalikulonasale Schienung mit autostabilen Silikonverweilsonden.

Trauma of the medial canthal region can affect all parts of the lacrimal ducts. Depending on the patient's age, there may be different mechanisms of injury. Surgical reconstruction using two autostable ("self-retaining") monocanaliculonasal lacrimal tubes is demonstrated by two case reports. Here, a 6 years old girl attacked by a dog (Rottweiler) showed severe periocular soft tissue damage with deep involvement of the lacrimal ducts. The child's inferior canaliculus was lacerated. Furthermore, the common canaliculus was dissected from the lacrimal sac. Deep soft tissue damage consisted of blunt and sharp injuries down to the cheek and nose. After lacrimal intubation with two autostable monocanaliculonasal tubes, the soft tissue was reconstructed by direct canalicular suturing and stepwise closure of each layer. One of the lacrimal tubes was fixated at the lid by additional sutures, in order to avoid stent prolapse. Beside slight medial depression of inferior lid, there were no signs of functional disturbance of the lacrimal ducts. The follow-up was 18 months. The second case report presents a 43 years old man. He accidentally cut himself with a butcher's knife. He suffered a deep wound of his medial canthal region. The patient presented with proximal (located near the lacrimal sac) laceration of both canaliculi. The medial canthal ligament as well as the orbicularis muscle had been cut. Using two autostable monocanaliculonasal lacrimal tubes, the lacrimal ducts were stented and reconstructed with sutures. During the follow-up of 6 months, no epiphora or mucopurulent lacrimal discharge occurred. In lacrimal trauma, different parts of the lacrimal ducts may be affected at the same time. Identification of the injured structures with respect to the kind of injury, localisation and the extent of damage is crucial. Stepwise wound closure in respect to the topographic anatomy is mandatory. Here, lid and lacrimal ducts must be respected as one functional unit. Simultaneous use of autostable monocanaliculonasal lacrimal tubes in both canaliculi can be applied for trauma reconstruction of the lacrimal ducts in children and adults.

[Primary Reconstruction of Lacrimal Ducts after Trauma - Bicanaliculonasal Intubation Using Autostable Tubes]. / Primäre Rekonstruktion der ableitenden Tränenwege nach Trauma ­ bikanalikulonasale Schienung mit autostabilen Silikonverweilsonden.

Trauma of the medial canthal region can affect all parts of the lacrimal ducts. Depending on the patient's age, there may be different mechanisms of injury. Surgical reconstruction using two autostable ("self-retaining") monocanaliculonasal lacrimal tubes is demonstrated by two case reports. Here, a 6 years old girl attacked by a dog (Rottweiler) showed severe periocular soft tissue damage with deep involvement of the lacrimal ducts. The child's inferior canaliculus was lacerated. Furthermore, the common canaliculus was dissected from the lacrimal sac. Deep soft tissue damage consisted of blunt and sharp injuries down to the cheek and nose. After lacrimal intubation with two autostable monocanaliculonasal tubes, the soft tissue was reconstructed by direct canalicular suturing and stepwise closure of each layer. One of the lacrimal tubes was fixated at the lid by additional sutures, in order to avoid stent prolapse. Beside slight medial depression of inferior lid, there were no signs of functional disturbance of the lacrimal ducts. The follow-up was 18 months. The second case report presents a 43 years old man. He accidentally cut himself with a butcher's knife. He suffered a deep wound of his medial canthal region. The patient presented with proximal (located near the lacrimal sac) laceration of both canaliculi. The medial canthal ligament as well as the orbicularis muscle had been cut. Using two autostable monocanaliculonasal lacrimal tubes, the lacrimal ducts were stented and reconstructed with sutures. During the follow-up of 6 months, no epiphora or mucopurulent lacrimal discharge occurred. In lacrimal trauma, different parts of the lacrimal ducts may be affected at the same time. Identification of the injured structures with respect to the kind of injury, localisation and the extent of damage is crucial. Stepwise wound closure in respect to the topographic anatomy is mandatory. Here, lid and lacrimal ducts must be respected as one functional unit. Simultaneous use of autostable monocanaliculonasal lacrimal tubes in both canaliculi can be applied for trauma reconstruction of the lacrimal ducts in children and adults.

[Interdisciplinary Management of Tumours of the Eyelid and Periorbital Region]. / Interdisziplinäres Management von Tumoren der Lid- und Periorbitalregion.

INTRODUCTION: Skin malignancies are typically localised in areas of the head that are exposed to the sun. Basal cell carcinomas (BCC) are the most frequent malignancies on the facial skin. Their incidence is raising - due to demographic changes. As regards strategies for resection and reconstruction, the eyelids and the periorbital region are extremely complex and have to be treated in an interdisciplinary context. The aim of the present investigation was to analyse the results of interdisciplinary treatment of periorbital and eyelid non-melanotic malignoma. MATERIALS AND METHODS: All treated non-melanotic malignancies of the eyelid/periorbital region were analysed in a pilot study from September 2017 until July 2019. Patients were treated by an ophthalmologist and a maxillofacial plastic surgeon. The clinical and pathological parameters were collected in a databank. In all interdisciplinary cases, the tumour localisation, histology, R-status and the reconstructive strategy were analysed. RESULTS: Out of 349 patients, 14 were analysed as they were treated with an interdisciplinary approach. The youngest was 12, the oldest 98 years old. There were 6 women (average age 80.3 years) and 8 men (average age 65.3 years). BCC (n = 10) were the most frequent malignancy; 3 patients suffered from squamous cell carcinoma. Actinic keratosis was diagnosed in one case. In all patients, complete resection (R0) was certified by histopathological examination. The reconstruction was performed immediately in 6 cases, and the reconstruction strategy was accomplished after definitive histology (at least two step procedures) in 8 cases. Only one patient had three resections before starting the reconstruction procedure. DISCUSSION: Surgical treatment of malignancies of the eyelid or periorbital non-melanotic malignancies can be an interdisciplinary challenge. BCC is the most frequent entity. These critically localised BCC present with extremely deep infiltration, followed by subtotal or total eyelid resection, often including bony structures. The reconstruction is extremely complex in such cases and requires the whole plastic reconstructive repertoire of both medical disciplines.

[Orbital Amyloidosis - Comparison of Two Different Clinical Courses]. / Orbitale Amyloidose ­ Vergleich zweier unterschiedlicher klinischer Verläufe.

BACKGROUND: Primary localised orbital amyloidosis (PLOA) is a very rare disease. In contrast to the isolated manifestation, systemic involvement can be associated with potentially life-threatening consequences. However, the isolated involvement of the orbit can also lead to serious complications. MATERIAL AND METHODS: Two cases of PLOA are described and the necessary ophthalmic, internistic and immunohistochemical diagnostic testing are explained. RESULTS: The first case describes a 71-year-old woman with PLOA. In the clinic, a yellow-orange bumpy prominence in the nasal lower quadrant without further ophthalmological abnormalities was found. Extensive diagnostic testing found no systemic manifestation. The patient herself was free of complaints. In the follow-up over 4 years, patient showed slow progression without ocular complications. The second case is a 72-year-old male patient with similar clinical signs but localisation in the temporal superior quadrant. During the clinical course, multiple ophthalmological complications developed (ptosis, protrusio bulbi, diplopia, secondary glaucoma, perforated corneal ulcer in neurotrophic keratopathy). Perforating keratoplasty had to be performed. Fractioned radiotherapy led to stabilisation of the disease. The follow-up period was 4 years. CONCLUSION: PLOA can lead to visual and organ threatening complications. Accurate diagnosis is required for further diagnostic and therapeutic procedures and to counteract potential local and systemic complications. Interindividual differences in the course have to be considered.

[Diseases and Surgery of the Orbit]. / Erkrankungen und Chirurgie der Orbita.

Most orbital diseases are rarely diagnosed in the clinic. Because the consequences for the eye can be severe, it is important to recognize the signs of orbital disease early in order to initiate the correct diagnostic and therapeutic steps in good time. This article presents the basics of the systematics, diagnostics and therapy of orbital diseases in preparation for the specialist examination for ENT medicine. Some orbital diseases are typical manifestations of systemic diseases (e. g. Graves' disease) or typical complications of diseases in the vicinity of the orbit (e. g. orbital complications from inflammatory or tumorous sinus diseases). The diseases of the lacrimal system and the eyelids as well as their therapy are closely related to the diseases of the orbit. Basically, it can be said that the diagnosis and therapy of orbital diseases should always be carried out on an interdisciplinary basis, whereby the involvement of the ophthalmologist is of particular importance.

[Disorders of the Lacrimal Apparatus, Part 2: Basics of Therapy]. / Erkrankungen des Tränenapparats, Teil 2: Grundlagen der Therapie.

The tearing eye (epiphora) is deemed to be the leading symptome of efferent tear duct stenosis. Nevertheless, epiphora might be caused by ocular surface pathologies or even intraocular diseases. A distinguished anamnesis and sufficient clinical examination is most meaningful for the differential diagnostic distinction. Therapy is based on pathologic changes. In case of ocular surface disease, a suitable tear substitution and antiinflammatory approach is mandatory. Multifarious triggers have to be considered as well. Addressing tear film distribution, suitable oculoplastic surgery is required. Efferent tear duct stenosis necessitates surgical treatment as the level of suffering is often very high and acute exacerbations may develop. Besides recanalization, anastomosing techniques represent the available therapeutic principles. Possible surgical approaches offer a great variety and many influencing factors navigate therapy decisions. This part of the review comments on the most important therapeutic approaches for lacrimal apparatus diseases.

[Disorders of the Lacrimal Apparatus, Part 1: Anatomy, Physiology, Diagnostics]. / Erkrankungen des Tränenapparats, Teil 1: Anatomie, Physiologie und Diagnostik.

The lacrimal apparatus is a part of the ocular adnexa preserving ocular surface homoeostasis and therefore enabling sufficiant visual functioning. Tear producting tissues, eyelids and efferent tear ducts operate as one functional unit. Pathologic changes consist of inflammatory diseases, congenital disorders, degenerations and neoplasia. Common to all these conditions is a potential impairment of the ocular integrity as well as a substantial degree of suffering for the affected patients. This review reflects basics of the anatomy, physiology, and diagnostics of the lacrimal apparatus.

[Traumatic Macular Hole]. / Traumatisches Makulaforamen.

The traumatic macular hole (TMH) is a rare complication of a blunt or an open injury of the globe and can lead to permanent loss of vision. The pathomechanism of TMH differs from that of the idiopathic macular hole (IMH). A sudden compression and expansion of the globe leads to vitreous traction, which can result in a TMH. The final visual acuity depends on the severity of the disruption of the photoreceptors and the retinal pigment epithelial cells. The posttraumatic approach is discussed controversially. A spontaneous closure and, therefore, a conservative approach should be considered in young patients with minor defects and good visual acuity without detachment of the posterior vitreous body. In these cases, it is advisable to wait for months. In the absence of adhesion at the edges of the hole and concomitant pathologies of the pigment epithelium, the spontaneous closure is improbable. In this case, a pars plana vitrectomy with removal of the vitreous and epiretinal membranes can lead to anatomical reconstruction and improvement of the visual acuity. The success of an operative intervention is complex and is associated with the experience of the surgeon as well as the characteristics of the trauma.