Nicht-infektiöse Konjunktivitis

Ob allergisch, autoimmun, toxisch oder mechanisch bedingt – die nicht-infektiöse Konjunktivitis ist ein Chamäleon unter den Augenerkrankungen. Dieser Beitrag beleuchtet differenzialdiagnostische Herausforderungen, pathophysiologische Mechanismen und moderne Therapieansätze von Keratokonjunktivitis vernalis über Graft-versus-Host-Erkrankung bis hin zum okulären Pemphigoid.

Abstract

The conjunctiva is a central component of the ocular mucosal system and, together with the Meibomian glands of the eyelids and the lacrimal glands, fulfills nutritive and defensive functions on the ocular surface. The conjunctiva is integrated into a dense neural and immunological network called the “Conjunctiva-associated Lymphoid Tissue” (CALT) [1] [2]. This network perceives various stimuli and responds in a finely tuned manner to provide protection while minimizing collateral damage. This must be viewed in the context of resident microorganisms (“commensal flora”) colonizing the conjunctiva (microbiome), and numerous biophysical factors that can disrupt the homeostasis of the ocular surface. Inflammatory changes are of primary concern and are differentiated according to their origin as either infectious or non-infectious. This CME article provides an overview of non-infectious inflammatory pathologies.

Kernaussagen

• Nicht-infektiöse Konjunktivitiden entstehen durch immunologische, allergische, toxische oder mechanische Reize und können lokal oder systemisch bedingt sein.

• Keratokonjunktivitis vernalis (VKC): eine chronisch-rezidivierende Erkrankung bei Kindern mit potenziell schwerer Hornhautbeteiligung, die frühzeitig behandelt werden muss.

• Atopische Keratokonjunktivitis (AKC): chronische Augenentzündung bei atopischer Diathese, oft mit schwerem narbigem Verlauf und systemischer Mitbeteiligung.

• Gigantopapilläre Konjunktivitis (GPC): mechanisch getriggerte, nicht-allergische Reaktion bei Kontaktlinsenträgern – Therapie besteht primär in der Karenz des Auslösers.

• Konjunktivitis lignosa: seltene, rezidivierende Pseudomembranbildung bei Plasminogenmangel – eine systemische Grunderkrankung mit okulärer Manifestation.

• Okuläres Schleimhautpemphigoid: Autoimmunerkrankung mit progressiver Fibrosierung der Bindehaut – systemische Immunsuppression ist essenziell zur Erblindungsprävention.

• Epidermale Nekrolyse (SJS/TEN): lebensbedrohliche, meist arzneimittelinduzierte Reaktion – frühe ophthalmologische Mitbeurteilung zur Vermeidung bleibender Schäden entscheidend.

• Graft-versus-Host-Erkrankung (GvHD): häufige okuläre Manifestation nach Stammzelltransplantation – systemische Therapie plus Tränenersatz und lokale Immunsuppression.

• Toxische Konjunktivitis: häufig iatrogen durch Medikamente oder Konservierungsmittel ausgelöst – Absetzen des Triggers plus symptomatische Therapie erforderlich.

Schlüsselwörter

nicht-infektiöse Konjunktivitis - allergisch - vernalis - okuläres Schleimhautpemphigoid - okuläre Graft-versus-host-Erkrankung

Keywords

noninfectious conjunctivitis - allergic - vernalis - ocular mucous membrane pemphigoid - ocular graft-versus-host-disease

Publication History

Article published online:
19 August 2025

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