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Typische Fragen aus der Rheumatologie an den Augenarzt und den kooperierenden Radiologen

Typical questions from the rheumatologist to the ophthalmologist and cooperating radiologist

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Zusammenfassung

Patienten mit rheumatologischen Problemen können im Augenbereich sehr heterogene akute oder chronische Symptome aufweisen. Neben Schmerzen und Bewegungseinschränkungen können Sehverlust und irreversible Zerstörung des Auges vorkommen. Das rote Auge, als leicht erkennbares Symptom, kann sehr viele verschiedene Ursachen haben. Benetzungsstörungen sind bei rheumatologischen Patienten häufig symptomatisch. Jeder ophthalmologische/rheumatologische Fall sollte auf mögliche Infektionserkrankungen oder ein Maskeradesyndrom geprüft werden. Liegen entzündliche Augenveränderungen vor, so sollte der Augenarzt aufgrund seiner spezifischen klinischen Kenntnisse den labordiagnostischen Weg vorgeben. Bei der juvenilen idiopathischen Arthritis muss je nach Gelenkbefallsmuster mit einem hohen Uveitisrisiko gerechnet werden. Während bei der Episkleritis eine zugrunde liegende Systemerkrankung eher selten beobachtet wird, ist diese bei einer Skleritis in der Hälfte aller Fälle gegeben. Ein Hornhautulkus ist immer ein ophthalmologischer Notfall und erfordert mitunter neben einer systemischen konservativen Therapie auch eine gezielte operative Versorgung. Das therapeutische Arsenal des Rheumatologen muss der Augenarzt in Einzelfällen durch lokale Medikamentengaben oder operative Maßnahmen bereichern. Das Ausmaß der entzündlichen Raumforderung im Auge bzw. in der Augenhöhle kann durch bildgebende Verfahren objektiviert werden. Es gibt wenige spezifische Nebenwirkungen rheumatologischer Therapeutika, die der Augenarzt kennen sollte, um selten auftretende schwerwiegende Nebenwirkungen frühzeitig zu erkennen.

Abstract

Patients with rheumatic disorders may suffer from various acute or chronic ocular symptoms. In addition to pain and motility disorders, loss of vision, and irreversible deterioration of the eye may occur. Red eye, a symptom easily identified, can be a sign of rheumatic involvement, but can also have a variety of other causes. Dry eye is frequently present in rheumatic patients. It is always important that infections and masquerade syndromes are ruled out in the differential diagnoses of any ocular inflammation. In cases of ocular inflammation the ophthalmologist should determine the diagnostic procedure on the basis of his clinical experience. Uveitis is a common complication of juvenile idiopathic arthritis depending on the subtype of arthritis. Patients with episcleritis rarely suffer from systemic inflammation, while inflammation is found in half of all cases of scleritis. Corneal ulceration should always be managed as an emergency case and, in addition to systemic medication, surgical intervention is often indicated. The degree of orbital or ocular involvement can be objectively monitored using modern imaging techniques. Medications against rheumatic inflammation may rarely result in ocular side effects, which should be detected early by the eye specialist.

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  1. Interdisziplinäres Vaskulitiszentrum am Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland

    B. Nölle, M. Both, M. Heller & J.B. Roider

  2. Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Hegewischstr. 2, 24105, Kiel, Deutschland

    B. Nölle & J.B. Roider

  3. Klinik für Diagnosische Radiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    M. Both & M. Heller

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Nölle, B., Both, M., Heller, M. et al. Typische Fragen aus der Rheumatologie an den Augenarzt und den kooperierenden Radiologen. Z. Rheumatol. 67, 360–371 (2008). https://doi.org/10.1007/s00393-008-0336-z

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