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.

Patofisiologi dan Gejala Klinis

Dry eye

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 Lapisan mucin
Gangguan

Lapisan lemak Fungsi : mencegah penguapan

Faktor resiko

Lapisan Aquos Fungsi : Pelarut O, CO, mengandung Elektrolit, protein, antibodi, dll

Lapisan Musin Fungsi : mempertahankan stabilitas air mata

Gejala klinis
Mata perih Iritasi Nyeri Rasa tidak nyaman/intoleransi saat menggunakan lensa kontak

Dry Eye Syndrome

Melisa Indah P 201010330211014

Dry Eye Disease: Predisposing Factors

Aging Menopause - Decreased Androgens Allergy Response Environmental Stresses
Contact Lens Wear Wind Air Pollution Low Humidity: Heating/Air Cond. Lack of Sleep Use of Computer Terminals

Ocular Surgery (LASIK, Corneal Transplant) Medications

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.

Lemp CLAO J 1995;21:221

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
et al. Am J Ophthalmol. 2003; et al. JAMA. 2001; 3Lemp. CLAO J. 1995; 4Multi-Sponsor Surveys, Inc. The 2005 Gallup Study of Dry Eye Sufferers. 2005.
2Schaumberg 1Schaumberg

Identifying Potential Dry Eye Patients

No

1. Do your eyes feel dry, painful, or sore? 2. Do you experience episodes or periods
of 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 General Symptoms
Symptoms: Itchy, Sandy, Gritty, Dry Discomfort: Stinging, Burning, Pain Vision: Blurring, Interrupted

1 Mild Symptoms
Never to Seldom

2 Moderate Symptoms
Sometimes

3 Severe Symptoms
Frequent

4 Severe Symptoms
Always

No

Yes

Yes

Yes

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 pratiwi 201010330311024

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.

Clinical Presentation Can Vary in Severity

Mild Slitlamp Severe

Fluorescein Dye Stain

Epitel rusak dan erosierosi kecil. Filamen epitelial dan mukosa khas, terutama di belahan bawah kornea
Lemp, 1995; Marsh et al, 1999

Potential Severe Consequences of Untreated Dry Eye Disease

Ulcus Cornea

Bacterial Keratitis

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