Keratoconjunctivitis vernalis

 

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Zusammenfassung

Die vernale Keratokonjunktivitis (VKC) gehört zu den allergischen Erkrankungen. Das Auftreten variiert erheblich in Abhängigkeit von der Klimazone. Kommt die VKC in gemäßigten Klimazonen nur saisonal vor, so finden sich in den Tropen meist ganzjährige und schwere Verläufe. Am häufigsten sind Jungen in der 1. Lebensdekade betroffen. Pathophysiologische Besonderheit ist ein dichtes, gemischtzelliges Infiltrat unter dem z. T. extrem verdickten Epithel. Es zeigen sich ausgeprägte Kapillarproliferationen, Fibrozytenstränge und eine verbreiterte extrazelluläre Matrix. Die Entzündungsreaktionen schließen IgE-und nicht IgE-vermittelte Entzündungsreaktionen ein. Das klinische Bild zeichnet sich durch ausgeprägte subjektive Symptome und die Entstehung von Riesenpapillen der oberen tarsalen Bindehaut aus. Unterschieden werden eine limbale und eine palpebrale Form. Hornhautveränderungen sind die bedrohlichsten Komplikationen mit Entwicklung von Hornhauterosionen und Ulzera. Therapeutisch kommen vorwiegend Präparate zum Einsatz, welche die Freisetzung von entzündlichen Botenstoffen wie das Histamin blockieren. Dies sind meist lokale Antihistaminika, Mastzellstabilisatoren und Dual-Action-Präparate. Topische Steroide oder topische Calcineurininhibitoren sind schweren Verläufen vorbehalten. Gleiches gilt auch für den Einsatz von systemischen Kortikosteroiden oder neuen Biologika, z. B. IgE-Inhibitoren. Eine operative Therapie ist insbesondere bei Hornhautkomplikationen erforderlich. In den Phasen einer akuten Entzündung mit der Gefahr von sehbedrohenden Komplikationen ist eine Therapie immer angezeigt.

Abstract

Vernal keratoconjunctivitis (VKC) belongs to the group of allergic eye diseases. The incidence varies considerably, depending on the climate zone. In temperate climates VKC occurs only seasonally, while in hot climates it is mostly all year-round and rather more severe. Most commonly boys are affected in the first decade of life. Pathophysiological feature is a dense mixed cellular infiltrate with sometimes extremely thickened epithelium. It shows pronounced capillary proliferation, fibrosis and a thickened extracellular matrix. Inflammatory responses can be divided into IgE-mediated and non-IgE mediated inflammation. The clinical picture is characterised by pronounced subjective symptoms and the emergence of giant papillae, mostly on the upper tarsal conjunctiva. Distinction can be made into a limbal form and a palpebral form. Corneal changes are the most threatening complications with development of corneal erosions and shield ulcers. The therapeutic approach uses mainly drugs to block the release of inflammatory mediators such as histamine. These are usually local antihistamines and dual action preparations. Topical steroids or topical calcineurin inhibitors are only used in more severe situations. The same applies for the use of systemic corticosteroids or new biologics e.g., IgE inhibitors. Surgical therapy is predominantly required for the treatment of corneal complications. In general, VKC usually has a self-limiting course. However, during phases of inflammation with the risk of developing vision-threatening complications therapy is always indicated.

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