Dry Eye Syndrome

DES

• Keratoconjunctivitis sicca (KCS), also called keratitis sicca,xerophthalmia or dry eye syndrome (DES).

What is Dry Eye Syndrome?

• Disease of ocular surfance caused by disturbances of natural function and protection of external eye leading to an unstable tear film when eye in open.

Prevalence of Dry Eye Syndrome

• Average age of a dry eye patient is 54 most are women.

• Dry Eye Syndrome affects 75% 0f people over age 65.

• Common reason for ophthalmologist visits.

Dry eye

Patofisiologi dan Gejala Klinis

Faktor Resiko

Faktor resiko : • usia lanjut• Kontak lens• Faktor hormonal• Obat-obat penurun produksi air mata• Faktor lingkungan (udara pans dan

kering,asap, polusi udara, angin, berada di ruang AC terus menerus dll)

Patofisiologi

• Mempengaruhi lapisan air mata– Lapisan lemak– Lapisan aquos Gangguan – Lapisan mucin

Faktor resiko

Lapisan lemakFungsi : mencegah penguapan

Lapisan AquosFungsi : Pelarut O₂, CO₂, mengandungElektrolit, protein, antibodi, dll

Lapisan MusinFungsi : mempertahankan stabilitas air mata

Gejala klinis

• Mata perih• Iritasi • Nyeri • Rasa tidak nyaman/intoleransi saat

menggunakan lensa kontak

Dry Eye Syndrome

Melisa Indah P201010330211014

Dry Eye Disease: Predisposing Factors

• Aging• Menopause - Decreased Androgens • Allergy Response• Environmental Stresses

– Contact Lens Wear– Wind– Air Pollution

• Ocular Surgery (LASIK, Corneal Transplant)• Medications

– Low Humidity: Heating/Air Cond.– Lack of Sleep– Use of Computer Terminals

Lemp CLAO J 1995;21:221

Dry Eye Disease Symptoms• Discomfort• Dryness• Burning, Stinging• Foreign-Body Sensation• Gritty Feeling, Stickiness• Blurry Vision• Photophobia, Itching, Redness

Note: Symptoms seldom correlate with clinical signs.

Patient Types with High Incidence of Dry Eye Disease

• Women aged 50 or older1

• Women using postmenopausal hormone replacement therapy2

• Those with ocular comorbidities3

• Contact lens wearers3

• Smokers4

• Users of artificial tears ≥ 3 times/day

1Schaumberg et al. Am J Ophthalmol. 2003;2Schaumberg et al. JAMA. 2001;

3Lemp. CLAO J. 1995;4Multi-Sponsor Surveys, Inc. The 2005 Gallup Study of Dry Eye Sufferers. 2005.

Identifying Potential Dry Eye Patients

No1. Do your eyes feel dry, painful, or sore?

2. Do you experience episodes or periodsof blurred vision?

3. How often are your eyes sensitive to light?

4. Do you have problems with your eyes when you are working on a computer, watching TV, or reading?

5. Do you use artificial tears three or more times a day?

Diagnosing Dry Eye Disease

• Patients who answer “yes” to any one of the previous questions should be evaluated for dry eye disease

• Many clinicians use clinical tests plus symptoms and patient history to diagnose1

1Nichols et al. Cornea. 2000.

Schirmer Test

Without Anesthesia• Measures reflex

tear secretion.

With Anesthesia• Eliminates

stimulated tearing.

Fluorescein Tear Break up time

Result

• Les than 3s classified clinical dry eye syndrome

• Found dry spot area when interval between a complete blink

Symptoms of Dry Eye

Dry Eye Severity Level 1 2 3 4

General Symptoms Mild Symptoms

Moderate Symptoms

Severe Symptoms

Severe Symptoms

Symptoms: Itchy, Sandy, Gritty, Dry

Never to Seldom Sometimes Frequent Always

Discomfort: Stinging, Burning, Pain

No Yes Yes Yes

Vision: Blurring, Interrupted No No Sometimes Usually

Use of Artificial Tears

Less than 2X per day

Several times per

day

Several times per

day

Several times per

day

McDonnell et al. ARVO. 2004.

Referensi

• American Optometric Association. 2013.Dry Eye Syndrome

• National Eye Institute. 2013. Dry Eye

Terima Kasih

Dry eye syndrome Treatment

Tristy yunita pratiwi201010330311024

Treatment for dry eye syndrome depends on whether symptoms are due to:

• Not enough watery tears• Too much evaporation• Assosiated disease• Caused by medication• Hormones and nervous system

Lubricant treatment

• Mild to moderate cases of dry eye syndrome

• Consist of a range of drops, gel and ointments

• to replace thre missing waterin the tearfilm

Preservative- free drops

• Contains preservative• Non-preservative >6x /day

‘Oily tear’ eye drops

• Replenish the oily tear and reduce evaporation• These preparation include synthetic guar gum or

liposomal sprays• The liposomes are sprayed on the closed eyelid

margins

Eye ointment

• Help lubricate the eyes• Best to use it at night• Dont use it if wear contact lenses

Anti-inflamatory treatments

• Steroid eye drops and ointments• Oral tetracyclines• Ciclosporin eye drops• Steroid eye drops and oitments

Autologous serum eye drops

• Only available from national blood service through an ophtalmologist and after approvalof funding application

• BLOOD blood cells are removed from the whole blood serum put into eye dropper bottle

Punctal occlusion

• Punctal occlusion involves using smalll plugs called punctal plugs tears will not drain into the tear ducts eyes remain moist

• Temporary plugs made by silicone first step to determine has a positive effect or not permanent plug

Salivary gland autotransplantation

• Removing some of the glands that produce saliva from lower lip and placing of graftingthem into the side of eyes.

• The saliva produced by the glands acts as a substitute for tears

Prognosis

Secara umum prognosis untuk ketajaman visual pada pasien dry eye syndrome adalah baik.

Komplikasi Dry Eye Syndrome

• Awal perjalanan: penglihatan sedikit terganggu

• Keadaan lanjut: ulkus kornea, penipisan kornea dan perforasi.

• Infeksi sekunder

Terapi dini dapat mencegah komplikasi tersebut.

Lemp, 1995; Marsh et al, 1999

Slitlamp

FluoresceinDye Stain

Mild Severe

Clinical Presentation Can Vary in Severity

Epitel rusak dan erosi- erosi kecil.Filamen epitelial dan mukosa khas, terutama di belahan bawah kornea

Bacterial Keratitis

Potential Severe Consequences of Untreated Dry Eye Disease

Ulcus Cornea

Edukasi

• Istirahat selama 15 menit terhadap penggunaan selama komputer 2 jam

• Sebaiknya tempat kerja memberikan penambahan jumlah jendela & ventilasi, lampu / cat dinding yg terang shg pekerja merasa nyaman.

• mengurangi pemakaian AC• cukup tidur dan diet yang seimbang dengan

komponen lemak Omega 3 yang cukup,

Ergonomics

Referensi

Foster,C.S. 13 May 2009. Dry Eye Syndrome. Available at :file:///D:/Dry Eye Syndrome.htm

Vaughan G.D., Asbury T, Eva P.R, 2012. Oftalmologi Umum, Jakarta. Widya Medika

Dr. Kanwar A. Singh MD “Dry Eye The Eye Centers of Racine and Kenosha”