title: Flammer syndrome.
abstract: The new term Flammer syndrome describes a phenotype characterized by the presence of primary vascular dysregulation together with a cluster of symptoms and signs that may occur in healthy people as well as people with disease. Typically, the blood vessels of the subjects with Flammer syndrome react differently to a number of stimuli, such as cold and physical or emotional stress. Nearly all organs, particularly the eye, can be involved. Although the syndrome has some advantages, such as protection against the development of atherosclerosis, Flammer syndrome also contributes to certain diseases, such as normal tension glaucoma. The syndrome occurs more often in women than in men, in slender people than in obese subjects, in people with indoor rather than outdoor jobs, and in academics than in blue collar workers. Affected subjects tend to have cold extremities, low blood pressure, prolonged sleep onset time, shifted circadian rhythm, reduced feeling of thirst, altered drug sensitivity, and increased general sensitivity, including pain sensitivity. The plasma level of endothelin-1 is slightly increased, and the gene expression in lymphocytes is changed. In the eye, the retinal vessels are stiffer and their spatial variability larger; the autoregulation of ocular blood flow is decreased. Glaucoma patients with Flammer syndrome have an increased frequency of the following: optic disc hemorrhages, activated retinal astrocytes, elevated retinal venous pressure, optic nerve compartmentalization, fluctuating diffuse visual field defects, and elevated oxidative stress. Further research should lead to a more concise definition, a precise diagnosis, and tools for recognizing people at risk. This may ultimately lead to more efficient and more personalized treatment.
authors: Department of Ophthalmology, University of Basel, Mittlere Strasse 91, 4031 Basel, Switzerland.
authors: Katarzyna
authors: K
authors: Konieczka
authors: Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA.
authors: Robert
authors: R
authors: Ritch
authors: Clinica Oculistica, Di.N.O.G.M.I., University of Genova, 16132 Genova, Italy.
authors: Carlo Enrico
authors: CE
authors: Traverso
authors: Department of Ophthalmology, Seoul National University, Seoul 110-744, Korea.
authors: Dong Myung
authors: DM
authors: Kim
authors: Department of Ophthalmology, University of Ulsan, Seoul 680-749, Korea.
authors: Michael Scott
authors: MS
authors: Kook
authors: Department of Internal Medicine and Cardiology, Ospedale San Giovanni, 6500 Bellinzona, Switzerland.
authors: Augusto
authors: A
authors: Gallino
authors: Department of Radiology, Friedrich-Wilhelms-University of Bonn, 53113 Bonn, Germany.
authors: Olga
authors: O
authors: Golubnitschaja
authors: Eye Clinic Wittenbergplatz, 10789 Berlin, Germany.
authors: Carl
authors: C
authors: Erb
authors: Department of Ophthalmology, SALK/Paracelsus Medical University, 5020 Salzburg, Austria.
authors: Herbert A
authors: HA
authors: Reitsamer
authors: Department of Ophthalmology, Osaka Medical College, Takatsuki 569-8686, Japan.
authors: Teruyo
authors: T
authors: Kida
authors: Department of Diagnostic and Glaucoma, University of Medical and Biological Agency of the Russian Federation, 105077 Moscow, Russian Federation.
authors: Natalia
authors: N
authors: Kurysheva
authors: Eye Center of Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou 310009, China.
authors: Ke
authors: K
authors: Yao
keywords: Cold extremities; Flammer syndrome; Normal tension glaucoma; Optic disc hemorrhages; Predictive preventive personalized medicine; Primary vascular dysregulation; Retinal vein occlusion; Systemic hypotension; Tinnitus; Vasospasm