[Seasonal allergic conjunctivitis]. / Saisonale allergische Konjunktivitis.

Seasonal allergic conjunctivitis (SAC) is a frequent disease, which is often associated with allergic rhinitis and subsequently manifested as allergic rhinoconjunctivitis. In contrast to other types of chronic allergic conjunctivitis, the course of SAC is not sight-threatening. Pathogenetically, the underlying cause of SAC is an immunoglobulin E (IgE) mediated, Th2-driven type 1 hypersensitivity reaction. Clinically it presents with itching, light-red conjunctival injection as well as chemosis that exceeds the extent of conjunctival injection. The goals of treatment are relief of acute signs and symptoms, control of the underlying inflammatory process and utilization of preventive options. Dually effective local therapeutics combine the advantages of rapid action with a relatively long-lasting effect by a two-fold active approach. Specific immunotherapy is useful in selected patients.

[Seasonal and Perennial Allergic Rhinoconjunctivitis]. / Die saisonale und perenniale allergische Rhinokonjunktivitis.

Seasonsal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) as well as intermittent and persistent allergic rhinitis are widespread diseases. Because a combined occurrence of ocular and nasal symptoms is very common the summarising term allergic rhinoconjunctivitis is frequently used. SAC and PAC representing the two acute forms of allergic conjunctivitis account for more than 90% of all cases of allergic conjunctivitis. Compared to the chronic forms of allergic conjunctivitis their course of disease is milder. Nevertheless because of their high prevalence and the proven influence on patients' quality of life they possess clinical and socioeconomic relevance. Allergic rhinoconjunctivitis is caused by a type 1 IgE-mediated hypersensitivitity reaction that is provoked by aeroallergens in the majority of cases. The pathognomonic sign is itching. Besides, typical ocular findings are chemosis, conjunctival injection,watery secretion and lid swelling. Otorhinolaryngologists' findings include rhinorrhea, postnasal drip and sneezing. Problems in breathing through the nose resulting from nasal obstruction can cause impaired nighttime sleep and daytime somnolence. In addition to a reduction of allergen exposure by modification of environment and life style factors, in mild forms of SAC and PAC artificial tears are recommended. Topical antihistamines can generate rapid relief from acute symptoms and itching. Topical mast cell stabilisers however provide long-term effects. Dual action drugs that combine antihistamines and mast cell stabilisers show increased patient compliance due to reduced application frequency. Use of topical steroids should be cautious and only temporary. For prolonged treatment periods unpreserved anti-allergic eye-drops should be preferred. Combined topical antihistamines and new-generation topical nasal steroids often used by otorhinolaryngologists demonstrate a good safety profile without systemic side effects. In summary, allergic rhinoconjunctivitis represents a common disease pattern that can be treated effectively. Once it is diagnosed correctly targeted treatment results in improved patients' quality of life quickly.

[Evaluation of a new residency program at the department of ophthalmology of the Heinrich Heine University Düsseldorf]. / Evaluation eines neuen Weiterbildungsprogramms in der Augenklinik der Heinrich-Heine-Universität Düsseldorf.

BACKGROUND: The German ophthalmological training is still a very individually organized system with only one final oral examination at the end of the 5-year residency. At the beginning of 2013 a new residency program was introduced at the department of ophthalmology of the Heinrich-Heine University Duesseldorf. This study evaluated the resident satisfaction with the new concept. MATERIAL AND METHODS: The new residency program consists of three main changes: firstly a structured training with fixed rotation in the various subdisciplines of ophthalmology, secondly a list of practical skills examinations that has to be completed during the 5-year program and thirdly annual intermediate oral examinations. The satisfaction of the residents with the new program was anonymously evaluated with a Likert scale-based questionnaire with 15 items and additional free text comments. RESULTS: (1) The structured training was mostly rated positively and 9 out of 12 of residents favored a continuation of the training concept in this form. (2) Only 7 out of 11 residents (64 %) wanted to continue the practical skills examinations in this form and only approximately half of the residents saw a positive effect of these examinations. (3) Regarding the annual examinations 8 out of 11 residents (73 %) reported that the examinations helped them to assess their skills better, 91 % (10 out of 11) reported a learning motivation, 90 % (9 out of 10) an improvement in learning due to the examinations and 73 % (8 out of 11) were of the opinion that the examinations should take place regularly. DISCUSSION: The structured training and the annual examinations were positively evaluated. These changes could be effectively implemented even with a relatively small personnel structure. In comparison the practical skill examinations were rated relatively negatively, probably because of the further increase of daily work. The number of skills to be demonstrated is currently reduced and the integration of testing into the clinical routine of examiners and examinees is under revision.

[Keratomycosis - Therapy Standards and New Developments]. / Keratomykose - Therapiestandards und aktuelle Entwicklungen.

Mycotic keratitis is a comparatively rare but serious ophthalmological disease, that can possibly lead to a severe loss of vision up to blindness. Over the last two decades an increase of cases with mycotic keratitis has been noticed, which is possibly caused by an increased use of soft contact lenses. This article gives an overview of the typical clinical signs and symptoms of keratomycosis, tried and tested diagnostics and therapy as well as new diagnostic and therapeutic developments and findings.

[Comparison of the OSDI and SPEED questionnaires for the evaluation of dry eye disease in clinical routine]. / Vergleich des OSDI- und SPEED-Fragbogens zur Evaluation des Sicca-Syndroms in der klinischen Praxis.

BACKGROUND: For the diagnosis of dry eye, taking an accurate medical history of the patient is critical. For this purpose the ocular surface disease index (OSDI) can be regarded as the established standard questionnaire but the standard patient evaluation of eye dryness (SPEED) questionnaire has recently been developed. The advantages of the SPEED questionnaire are the lower number of questions and easier interpretability. MATERIAL AND METHODS: In a retrospective analysis of 153 patients of our special clinic for dry eyes we performed a comparison of the SPEED with the established OSDI questionnaire regarding the evaluation of the severity of dry eye. In addition, we analyzed possible correlations with various objective parameters for classification of dry eye syndrome. RESULTS: There was a highly significant correlation between OSDI and SPEED values with a correlation coefficient of 0.47 (p < 0.001). In addition, significant correlations between OSDI values and the tear meniscus height (r = - 0.1374, p = 0.0226), Schirmer values (r = - 0.26, p < 0.0001) and lid margins parallel conjunctival folds (r = 0.1261, p = 0.034) were observed. The SPEED values showed a significant correlation with age (r = - 0.2106, p = 0.0107) and lipid layer thickness (r = - 0.159, p = 0.0081). DISCUSSION: The OSDI and SPEED questionnaires are both suitable for detecting the symptoms of dry eye; however the results of the questionnaires cannot be used interchangeably. While the SPEED levels seemed to correlate more with the parameters of evaporative dry eye, the OSDI values were more correlated with parameters of aqueous tear-deficient dry eye. However, a distinction between evaporative and aqueous tear-deficient dry eye is not possible based only on the results of the questionnaires.

[Factors influencing the measurement of tear film lipid layer thickness with interferometry]. / Einflussfaktoren auf die Messung der Lipidschichtdicke des Tränenfilms mittels Interferometrie.

INTRODUCTION: The quantitative measurement of the tear film lipid layer thickness is a relatively new and promising method. However, so far it has not been investigated whether there is a diurnal or a day to day variability and whether certain factors are confounding the measurement of the lipid layer thickness. MATERIALS AND METHODS: In three different experimental settings, 10 subjects without known sicca syndrome were examined at three different time points on one day, on three different days and before and after therapeutic expression of the Meibomian glands. As a comparison, the parameters tear film break-up time, tear meniscus height, diagnostic expression of the Meibomian glands and subjective symptoms, determined using the OSDI (ocular surface disease index) questionnaire, were measured. RESULTS: The results of the study showed a smaller variation of the lipid layer thickness measurements during the day and from day to day compared to the tear film break-up time. The expression of the Meibomian glands significantly increased the lipid layer thickness. There was a correlation between the baseline values of tear film break-up time and the lipid layer thickness. DISCUSSION: Our data showed that the lipid layer thickness as measured with the Lipiview® interferometer appears to be a relatively constant parameter over time. In addition, the expression of the Meibomian glands could be identified as a potential confounding factor. In this study we included only healthy subjects without known sicca syndrome. For the future our findings need to be validated in dry eye patients.

[Seasonal and perennial allergic rhinoconjunctivitis]. / Die saisonale und perenniale allergische Rhinokonjunktivitis.

Seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) as well as intermittent and persistent allergic rhinitis are widespread diseases. Because a combined occurrence of ocular and nasal symptoms is very common the summarising term allergic rhinoconjunctivitis is frequently used. SAC and PAC representing the two acute forms of allergic conjunctivitis account for more than 90 % of all cases of allergic conjunctivitis. Compared to the chronic forms of allergic conjunctivitis their course of disease is milder. Nevertheless because of their high prevalence and the proven influence on patients' quality of life they possess clinical and socioeconomic relevance. Allergic rhinoconjunctivitis is caused by a type 1 IgE-mediated hypersensitivity reaction that is provoked by aeroallergens in the majority of cases. The pathognomonic sign is itching. Besides, typical ocular findings are chemosis, conjunctival injection, watery secretion and lid swelling. Otorhinolaryngologists' findings include rhinorrhea, postnasal drip and sneezing. Problems in breathing through the nose resulting from nasal obstruction can cause impaired nighttime sleep and daytime somnolence. In addition to a reduction of allergen exposure by modification of environment and life style factors, in mild forms of SAC and PAC artificial tears are recommended. Topical antihistamines can generate rapid relief from acute symptoms and itching. Topical mast cell stabilisers however provide long-term effects. Dual action drugs that combine antihistamines and mast cell stabilisers show increased patient compliance due to reduced application frequency. Use of topical steroids should be cautious and only temporary. For prolonged treatment periods unpreserved anti-allergic eye-drops should be preferred. Combined topical antihistamines and new-generation topical nasal steroids often used by otorhinolaryngologists demonstrate a good safety profile without systemic side effects. In summary, allergic rhinoconjunctivitis represents a common disease pattern that can be treated effectively. Once it is diagnosed correctly targeted treatment results in improved patients' quality of life quickly.

[Pseudoxanthoma elasticum. More than a skin problem]. / Pseudoxanthoma elasticum. Mehr als ein Hautproblem.

Pseudoxanthoma elasticum (PXE) is a rare genetic systemic disease with ectopic mineralization of the connective tissue leading to clinical manifestations in the skin, eyes and cardiovascular system. PXE is caused by mutations in the ABCC6 gene and is transmitted in an autosomal recessive manner. A 9-year-old boy presented with periumbilical skin findings since birth. The detection of typical retinal manifestations ("peau d'orange"-phenomenon) made possible a definite diagnosis, following the new diagnostic criteria for PXE from 2010. Curative treatment options are still unavailable so the interdisciplinary care of PXE patients by dermatologists, ophthalmologists and cardiologists appears to be pivotal to prevent severe ophthalmologic and cardiovascular complications.

[Meibomian gland dysfunction]. / Meibom-Drüsen-Dysfunktion.

Meibomian gland dysfunction (MGD) is a chronic disease, usually caused by obstruction of the secretory Meibomian glands. The subsequent reduction of gland secretion results in a decreased amount of lipids in the tear film. This results in a faster evaporation of the tear film and thus an evaporative dry eye. MGD alone is responsible for about 60% of all cases in combination with aqueous deficiency for a further 20% of dry eyes. While in Europe up to 20% of the population are suffering from MDD, this is true in Asia for over 60% of the population. MGD is more common in women and it incidence increases with age. It is influenced by the hormonal status as well as chemical and mechanical noxious stimuli. Additional risk factors include various skin diseases such as rosacea, acne or atopy. To diagnose MGD, particular attention should be paid to changes in the lid margin such as plugging or pouting of the ducts, thickening and telangiectasia. However, most important is the diagnostic expression of the glands. At first it should be assessed whether secretion can be caused by pressure to the eyelid against the globe and secondly the quality of the expressed secretions should be evaluated. MGD should be treated according to the severity of the disease. While in mild stages instructions for lid margin hygiene, warming and massage in combination with artificial tears might be sufficient, in more severe stages oral tetracyclin derivatives and anti-inflammatory eye drops such as steroids or CSA are necessary for successful treatment.

[Retinal arteritis in pregnancy]. / Retinale Arteriitis in der Schwangerschaft.

The case of a 35-year-old pregnant patient is described who presented with acute bilateral visual loss. As the reason for this a retinal arteritis could be demonstrated. The patient also suffered from acute unilateral hearing loss in combination with cerebral changes detectable by MRI. After exclusion of other causes the diagnosis of Susac syndrome (retinocochleocerebral microangiopathy) was made and appropriate therapy was initiated.

[Familial exudative vitreoretinopathy]. / Familiäre exsudative Vitreoretinopathie.

Familial exudative vitreoretinopathy (FEVR) is an autosomal dominant inherited disease with a penetrance of nearly 100% and is mostly found in Asia. The most important sign is a temporal avascular retina with pathologically changed vessels combined with a temporal dragging of the disk and a heterotopy of the macula. In contrast to retinopathy of prematurity, only full-term children without oxygen therapy are affected. Clinical severity is highly variable. A stage of an asymptomatic gene carrier with peripheral ischemia only visible on angiography up to a massive deterioration of vision because of a combined tractional and rhegmatogenous retinal detachment is possible. All stages with intra- or subretinal exudates require therapy. First-line therapy is the coagulation of the leaky vessels to reduce the exudation. In addition cryocoagulation is possible. Advanced stages with complex retinal detachments usually require a vitrectomy to prevent further loss of visual function.

[Retinal arteriovenous malformation]. / Retinale arteriovenöse Malformation.

The case of a 27-year-old patient is described who presented at our hospital with an asymptomatic retinal vascular alteration which was found during a routine check-up. The typical clinical presentation led to the diagnosis of an arteriovenous malformation. Further diagnostics did not show any indications for an involvement of brain or facial blood vessels.