[Dry eye syndrome and neurotrophic keratitis in childhood. Causes and therapy]

[Chronic Blepharitis]

Blepharitis represents a frequent inflammatory condition of the lids including the lid margin, which can be apparent in adults and children. Chronic blepharitis is therapeutically challenging. According to the anatomic localization, blepharitis can be graded in anterior and posterior forms. Blepharitis can lead to severe symptoms and complications, mainly dry eye disease, corneal complications and defective lid position. The pathogenesis of chronic blepharitis is not fully understood so far, however, multifactorial disease proceedings are supposed, which include systemic diseases (mainly dermatological disorders), habitual bacteria and infections. In all these processes inflammatory changes are the common final path.Therapeutic strategies include topical and systemic therapies, however evidence levels are generally low and patients are often resistant to therapy. Basic therapeutic measures are warm compresses, lid hygiene and lubricants. Topical anti-inflammatory drugs comprise corticosteroids and ciclosporin A. Topical and systemic antibiotics are commonly used. Systemic intake of omega-3 fatty acids is often recommended due to its anti-inflammatory potential.

Chronische Blepharitis

Blepharitis ist eine häufige entzündliche Erkrankung der Augenlider einschließlich des Lidrandes, die bei Erwachsenen und Kindern auftreten und schwere Symptome hervorrufen haben kann. Je nach anatomischer Lokalisation kann die Blepharitis in anteriore und posteriore Formen eingeteilt werden. Die Pathogenese der chronischen Blepharitis ist noch nicht vollständig geklärt, es wird jedoch ein multifaktorielles Krankheitsgeschehen vermutet. Die Erkrankung stellt eine therapeutische Herausforderung dar.

[Clinical picture and diagnosis of neurotrophic keratopathy]

BACKGROUND

Neurotrophic keratopathy is characterized by corneal surface alterations, persistent corneal epithelial defects and/or corneal ulcerations associated with corneal sensory abnormalities. Due to the variable clinical picture neurotrophic keratopathy is often overlooked or diagnosed too late in the course of the disease.

OBJECTIVE

Discussion of the clinical picture of neurotrophic keratopathy and recommendations for correct diagnosis.

MATERIAL AND METHODS

Analysis of the existing literature and discussion of basic recent publications.

RESULTS

Neurotrophic keratopathy is defined as a disease related to alterations in corneal nerves leading to impairment in sensory and trophic function with consequent breakdown of the corneal epithelium affecting health and integrity of the tear film, epithelium and stroma. It can occur with infections, autoimmune diseases, after trauma or ocular surgery, with intracranial neoplasia, in systemic diseases and genetic syndromes. It is classified into three stages: mild (epithelial changes without epithelial defects), moderate (epithelial defects) and severe (stromal involvement). The clinical hallmark is reduced or absent corneal sensation. Therefore, corneal sensitivity testing is essential in the diagnosis of neurotrophic keratopathy along with the patient history, clinical examination and diagnostic tests, such as vital stains and, if possible, in vivo confocal microscopy.

CONCLUSION

The correct diagnosis and classification of neurotrophic keratopathy enable a stage-adapted step-ladder therapeutic approach with subsequent reduction of progression and complications of the disease.