Dry Eye Syndrome
description
Transcript of Dry Eye Syndrome
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”