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Meibom-Drüsen

Teil III: Dysfunktion (MGD) – Plädoyer für ein eigenständiges Krankheitsbild und wichtige Ursache für das trockene Auge

Meibomian glands

Part III. Dysfunction – Argument for a discrete disease entity and as an important cause of dry eye

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Zusammenfassung

Die Dys- oder Fehlfunktion der Meibom-Drüsen („Meibomian gland dysfunction“, MGD), weitgehend synonym mit der hinteren Blepharitis, aber typischerweise ohne auffallende entzündliche Veränderung des Lidrands, sollte als ein eigenständiges Krankheitsbild klinisch mehr betrachtet und beachtet werden, weil es ein häufiger Grund für Benetzungsstörungen der Augenoberfläche im Sinne eines evaporativen trockenen Auges ist. In diesem Beitrag werden Historie, Klassifikation, Pathologie, Einflussfaktoren, Diagnostik und Therapie dargestellt und diskutiert. MGD beruht vorwiegend auf einer obstruktiven Störung durch verstärkte Verhornung des Ausführungsganges und/oder verdicktes Sekret mit nachfolgendem Mangel der oberflächlichen Lipidschicht des Tränenfilms. MGD ist vom Hormonstatus sowie von chemischen und mechanischen Noxen und auch von genetischen Störungen abhängig. Sie tritt bei Frauen gehäuft auf und nimmt generell mit dem Alter zu. Als Folgeveränderungen können sich Sekretstau in den Drüsen, Dilatation der Gänge und schließlich Atrophie und Untergang des Drüsengewebes entwickeln. Eine genaue Untersuchung der Augenlider und Lidränder (ggf. mit Evertierung) sollte daher bei jeder Benetzungsstörung durchgeführt werden, v. a. bei Anpassung von Kontaktlinsen. Wichtig sind die Inspektion der Drüsenöffnungen sowie eine diagnostische Expression unter geringem manuellem Druck auf das Lid.

Abstract

Meibomian gland dysfunction (MGD), mainly synonymous with posterior blepharitis but typically without prominent inflammatory alterations of the lid margin, is a discrete disease entity and a frequent cause of wetting deficiencies of the ocular surface leading to dry eye disease that deserves increased recognition by clinicians. The history, classification, pathology, influencing factors, diagnostics and therapy are explained and discussed. MGD is mainly based on an obstructive mechanism caused by hyperkeratinization of the excretory duct and/or increased viscosity of the secretion (meibum) with subsequent deficiency of the tear film lipid layer. MGD is influenced by the hormonal status and by chemical and mechanical noxes as well as genetic defects and it occurs more frequently in women and generally increases with age. It results in stasis of meibum inside the glands, dilatation of the ductal system and eventually in atrophy and loss of glandular tissue (gland dropout). Careful investigation of the eyelids and lid margins with eversion, if necessary, should therefore be performed in every case of a wetting defect, notably before fitting contact lenses. Particularly important is the inspection of the meibomian orifices and diagnostic expression by mild mechanical compression of the lid.

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Correspondence to E. Knop.

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Gewidmet dem kürzlich verstorbenen Jeffrey P. Gilbard, der die Bedeutung der Hyperosmolarität des Tränenfilms in der Pathogenese des „trockenen Auges“ bereits vor Jahren erkannte und ihren Zusammenhang mit obstruktiven Störungen der Meibom-Drüsen nachwies.

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Knop, E., Knop, N., Brewitt, H. et al. Meibom-Drüsen. Ophthalmologe 106, 966–979 (2009). https://doi.org/10.1007/s00347-009-2043-9

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