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Syndrom suchého oka

 Charakteristika:

 

Porucha kterékoliv součásti slz znamená poruchu integrity slzného filmu a může vést k symptomům a klinickým projevům suchého oka. Nejčastěji se může projevit v souvislosti s lokálními očními onemocněními, jako je chronický zánět okrajů víček a spojivek, při toxicitě lokálně používaných očních léků či při celkové léčbě - např. některými psychofarmaky, antihistaminiky nebo antihypertenzivy.

Syndrom suchého oka byl vždy spojován s některými autoimunitními onemocněními, jako je Sjögrenův syndrom, revmatoidní artritida, lupus erythematodes, oční jizevnatý pemphigoid či Stevensův-Johnsonův syndrom.

 

Příznaky:

Příznaky onemocnění jsou rozmanité - většina stížností se týká obecného diskomfortu očí. Je to pocit svědění, pálení, řezání, tlaku v očích, pocit písku či cizího tělíska, únava očí, někdy zarudnutí, obtíže při mrkání až jakési „drhnutí oka" při pohybu víček, někdy i fotofobie. Paradoxně se setkáváme s nadměrným slzením ve větru či v suchém a teplém prostředí - to je příznak, který paradoxně vytváří dojem nadbytku slz. Příčinu tohoto stavu vidíme v tvorbě nekvalitního slzného filmu, která je nahrazována nadměrnou produkcí. Typickým projevem je zhoršování obtíží v průběhu dne, při pobytu v zakouřeném a nedostatečně větraném prostředí, klimatizaci atd.

Léčba:

Léčba syndromu suchého oka má řadu možností. Většinou vystačíme s léčbou lokální, někdy však musíme přistoupit k léčbě komplexní - především u systémových onemocnění, jejichž hlavním představitelem je Sjögrenův syndrom. Při změnách slzných cest či deformací víček je indikována léčba chirurgická. 

Výběr léčby je závislý na stupni projevů. Cílem léčby je zlepšit kvalitu slzného filmu a tím snížit intenzitu vysychání oka. Zlepšení kvality slzného filmu je možné docílit používáním umělých slz nebo v kombinaci s gelovými preparáty. Pokud se umělé slzy kapou méně než 4× denně, je možné používat preparáty s obsahem konzervačních látek. Při potřebě častějšího kapání je vhodnější používat preparáty bez konzervačních látek. Časté kapání kapek je velmi obtěžující pro pacienta a použivání kapek s konzervační látkou může mít další nepříznivý vliv na oko. Proto v indikovaných případech (indikaci určuje ošetřující lékař) velkým přínosem je zavedení implantátů (ucpávek) do slzných kanálků k jejich dočasnému nebo trvalému uzavření, za účelem zablokování drenáže slz.  

Pacientka JANA s RA a syndromem suchého oka:

"Oči mě pálí už asi rok. Ráno po probuzení to bylo vždycky dobré, k večeru se to zhoršovalo a mívala jsem je dost často červené. Jednou jsem ráno sedla k počítači, podívala se do monitoru a oči mě začaly pálit, jako bych krájela cibuli. Hrozně slzely a začaly i řezat. Měla jsem pocit, že mám něco v oku pod víčky, jakoby písek když mrkám. Další den už jsem se nemohla na monitor, televizi a nic dalšího svítícího vůbec podívat. Vadilo mi i denní světlo, musela jsem nosit non stop sluneční brýle. To už byl dost silný impulz, že bych měla navštívit očního lékaře. Verdikt zněl Syndrom suchých očí a zánět z podráždění vnějších částí oka. Na jedné straně mám nedostatek slz, na straně druhé mi paradoxně oči přehnaně reagují velkým množstvím slz na světlo, vítr, nebo jakékoliv jiné podráždění. Asi po týdnu léčby, kdy jsem nemohla téměř vůbec na počítač, na televizi se nedívám doteď, už nemusím chodit se slunečními brýlemi doma, ale venku za slunečného počasí ano a na počítač je taky používám, bez nich se mi to okamžitě vrací."

Pacientka Hela s RA a syndromem suchého oka:

"Já mám naopak největší problémy v noci a po ránu, kdy vůbec nemůžu otevřít oko, víčko je úplně přilepené k oční bulvě. První otevření oka mi způsobilo vždy velikou bolest, oko se narušilo a viděla jsem pak několik dnů dvojitě. Navštívila jsem očního lékaře a ten hned konstatoval, že nemám slzy. Lékárna neplatí umělé slzy, které si musíme my s tímto problémem neustále kapat, tedy to přijde na nějakou tu stokorunu měsíčně. Musím kapat i v noci, kdy si dávám budík, jelikož oko nevydrží zvlhčené po celou noc. Jiné problémy s viděním nemám. Pravidelné kapání tento problém vyřešilo."


ČLÁNEK (STUDIE)

Syndrom suchého oka u pacientů s revmatoidní artritidou

Cílem průřezové studie bylo posoudit četnost výskytu syndromu suchého oka u pacientů s revmatoidní artritidou, zhodnotit souvislost mezi výskytem syndromu suchého oka, séropozitivitou, stadiem a délkou trvání RA.

Soubor tvořilo celkem 100 pacientů, 16 mužů a 84 žen, průměrný věk 58,9 let (SD 14,6). Průměrná doba trvání revmatoidní artritidy byla 12,3 roku, SD 11,0. U každého pacienta byl proveden Schirmerův test I, na štěrbinové lampě byla posouzena přítomnost spojivkových řas probíhajících souběžně s víčkem (Lid Parallel Conjunctival Folds - LIPCOF), byla změřena doba potřebná k roztržení slzného filmu (Tear Film Break-Up Time - BUT) a bylo provedeno vitální barvení fluoresceinem. U každého pacienta byl zaznamenán údaj o séropozitivitě či séronegativitě RA, stupni RA podle RTG postižení a délce trvání RA. Ke statistickému zpracování souvislosti mezi výskytem revmatoidní artritidy a syndromem suchého oka byl použit Pearsonovův asociační test pro nominální proměnné.

V našem souboru 100 pacientů byl pozitivní Schirmerův test I naměřen u 67 % pacientů. Pozitivní BUT jsme pozorovali u 84 % pacientů. Slizniční řasy byly přítomny pouze u 45 % pacientů. Patologický nález při barvení rohovky fluoresceinem se vyskytl u 18 % pacientů. Výskyt syndromu suchého oka jsme zaznamenali 74 % pacientů s RA. Subjektivní obtíže udávalo pouze 38,3 % pacientů. Zavedenou lokální terapii mělo jen 23,0 % pacientů. Neprokázali jsme statisticky významnou souvislost mezi výskytem séropozitivní revmatoidní artritidy a syndromem suchého oka, ani mezi stupněm revmatoidním artritidy a přítomností syndromu suchého oka. Prokázali jsme statistickou souvislost mezi výskytem syndromu suchého oka a délkou trvání RA déle než 10 let. Keratoconjunctivitis sicca je nečastější oční komplikací u pacientů s revmatoidní artritidou. Prokázali jsme souvislost mezi výskytem syndromu suchého oka a trváním RA déle než 10 let, neprokázali jsme vztah mezi séropozitivitou či stupněm RA a vznikem syndromu suchého oka. Včasná diagnostika syndromu suchého oka a účinná lokální terapie mohou předcházet vzniku velmi závažných a terapeuticky špatně ovlivnitelných rohovkových komplikací

Zdroj: http://prolekare.cz

 

 

 

 

 

 

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