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Czy cukrzyca może powodować rany w obrębie oczu?

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Cukrzyca może stanowić przyczynę uszkodzeń powierzchni oka. U chorych na tę chorobę odnotowuje się szerokie spektrum objawów związanych z narządem wzroku. Do najpoważniejszych symptomów należą uszkodzenia i nadżerki nabłonka oraz neurotroficzne owrzodzenia rogówki.

Przyczyny uszkodzeń oczu w przebiegu cukrzycy

W przebiegu cukrzycy może dojść do poważnych uszkodzeń powierzchni oka, których ostateczną konsekwencję może stanowić upośledzenie widzenia lub całkowita ślepota.

Główną przyczynę cukrzycowych zmian chorobowych w obrębie oczu stanowi zespół suchego oka. ZSO w przebiegu cukrzycy może być spowodowany przez zaburzenia metaboliczne i naczyniowe (mikroangiopatia cukrzycowa). Czynnikami ryzyka są także przewlekła hiperglikemia powodująca zwiększenie stężeń cytokin prozapalnych oraz cukrzycowa neuropatia. Wymienione zaburzenia prowadzą do dysfunkcji gruczołu łzowego i rozwoju procesów zapalnych, a w konsekwencji do degeneracji i ubytku tkanek. Upośledzenie prawidłowej funkcji łez może być również skutkiem działania leków stosowanych w cukrzycy.

Mikroangiopatia cukrzycowa może ponadto w połączeniu z akumulacją końcowych produktów glikacji białek powodować zaburzenia unerwienia. Nerwy rogówkowe pełnią funkcję neutrotroficzną poprzez wydzielanie mediatorów wzrostu komórek nabłonka oraz stymulację procesów gojenia. Z tego powodu w wyniku zaburzenia funkcjonowania nerwów rogówkowych może dojść do trudno gojących się lub nawet trwałych uszkodzeń nabłonka rogówki.

Powikłania rogówkowe w przebiegu cukrzycy

Wśród powikłań rogówkowych, które mogą wystąpić w związku z cukrzycą, wymienia się: zwiększoną podatność tkanek rogówki na uszkodzenia i opóźnione gojenie, punktową keratopatię, trwałe uszkodzenia oraz nawracające erozje komórek nabłonka, a także neutrotroficzne owrzodzenia rogówki. Erozje i owrzodzenia nabłonka rogówki mogą wykazywać trudności w gojeniu i nie poddawać się konwencjonalnej terapii.

Objawy zaburzeń narządu wzroku u chorych na cukrzycę

U chorych na cukrzycę, u których rozwinął się zespół suchego oka i inne towarzyszące mu zaburzenia, występują podobne objawy jak u pozostałych pacjentów cierpiących na ZSO. Są to: pieczenie i kłucie w obrębie oczu, uczucie ciała obcego w oku, zaburzenia widzenia. W części przypadków u pacjentów z cukrzycą objawy te mogą być mniej wyczuwalne. Ma to związek z obniżonym czuciem rogówkowym spowodowanym przez neuropatię.

Leczenie cukrzycowych uszkodzeń oczu

Bardzo istotne jest, aby leczenie zostało wdrożone na wczesnym etapie rozwoju zaburzeń. Dzięki temu możliwe jest uniknięcie poważnych powikłań takich jak owrzodzenie, bliznowacenie i perforacja rogówki, pogorszenie widzenia czy wtórne zapalenia bakteryjne.

W terapii stosuje się preparaty sztucznych łez oraz środki przeciwzapalne. Ponadto istotne jest również, by utrzymywać prawidłowe wartości glikemii.

Źródła:

  1. Bielecka, J. Szaflik, „Cukrzyca a choroby powierzchni oka”, „Świat Lekarza” 2018.
  2. Mrukwa-Kominek, M. Sarnat, Ł. Drzyzga, „Zaburzenia powierzchni oka u chorych na cukrzycę”, „Okulistyka po Dyplomie” 2012, 2(3): 15-18.

Przeczytaj także: Najczęstsze powikłania cukrzycy

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