[Psychosomatic symptoms in somatic diseases - open-angle glaucoma for example]. / Psychosomatische Symptome bei rein somatischen Krankheiten unter anderem am Beispiel eines chronischen Offenwinkelglaukoms.

Psychological aspects exist in somatic diseases like tumours and even fractures, not only in the beginning but also in the management of disease. Somatic diseases give rise to signs of a special constellation of life and management of these diseases is important for the psychological constellation of the individual. Studies on open-angle glaucoma have shown that many patients suffering from this disease are anxious, hypochondric, perfectionist and emotional instable. Chronic diseases are demanding processes of flexibility and defense, and define how the individual can deal with the diseases and what place in life the disease will occupy in the future. In the holistic view of medicine even psychological conflicts should be treated. In many situations, these conflicts are not consciously experienced by the individual. Therapeutically, 2 different tools can be used: symbolic stories can bring forces to manage the conflict and to solve the conflict (2 examples in the text). The method of positive psychotherapy describes the reasons for psychosomatic diseases in three parts: psychosomatic in the traditional understanding, in further and comprehensive understanding. Especially the psychosomatic effects in comprehensive understanding are embedded in the individual's sociocultural environment and provide tips on reasons for the diseases in those parts of life. The "positive balance model" gives an example of life-management and conflict-therapy. In ophthalmology, fear is often more important for the patient than pain. To avoid this, the patients develop techniques to deny, to cover or to suppress the fear. In the article questions are presented like those the ophthalmologist should be able to ask patients in the office concerning open-angle glaucoma. Tips for the therapy and management for neurotic stress are offered and some special anamnestic questions for the ophthalmologist are presented. Unsolved conflicts and denied desires as neurotic symptoms can be focused in symptoms of eye diseases. Macrotraumata and microtraumata may be reason for changes of the hormonal situation and subsequent destabilisation of the metabolism, hypertonic disease and variation of the intraocular pressure. This article gives an example of the therapeutic possibilities in somatic diseases, to discuss the psychic situation with the patient and to be able to give tips for self-help. Finally, the therapeutic procedere in patients with somatic and psychosomatic diseases is discussed and a 5-step model is presented.

[How did lacrimal endoscopy influence lacrimal surgery?]. / Wie hat die Tränenwegendoskopie die Tränenwegchirurgie beeinflusst?

Lacrimal surgery has been characterised by multiple rapid changes within the last 20 years. The understanding of the development and existence of lacrimal stenoses has changed considerably. New morphological (endoscopy of the lacrimal system) and anatomic-functional aspects have been added. In the field of surgery the frequency of DCR has dropped within the last years, but still, with proper indications, this method has its significance, as well as irrigation of the lacrimal system. On the other hand microendoscopic canalicular surgery has been almost fully replaced by microendoscopic transcanalicular laser dacryoplasty and microdrill dacryoplasty. For the surgical treatment of injuries of the lacrimal system no changes have been implemented. As a spin-off effect from gastroduodenoscopy and ERCP superfine endoscopes have been developed, and have opened the possibility to inspect the mucosa and directly evaluate the lumen of the lacrimal system. Following the development of laser dacryoplasty and microdrill dacryoplasty as well as miniaturised drill systems, surgery can be performed less invasively today. Future developments of lacrimal surgery will be strongly influenced by the ongoing developments of microendoscopic transcanalicular techniques and modulation in wound healing.