DRY EYE SYNDROME

(KERATOKONJUNGTIVITIS SICCA)

Pembimbing :
dr. Yusni, Sp.M
 EPIDEMIOLGI
Insiden sindrom ini sering terjadi orang usia
lanjut dan wanita menopause.

Faktor resiko terjadinya sindrom ini ialah

peningkatan polusi udara, penggunaan obat-
obatan tertentu seperti obat alergi dan obat
hipertensi, peningkatan pengguna lensa
kontak dan peningkatan penggunaan
komputer, serta penyakit sindrom syogren
 DEFINISI
Terjemahan dari "keratoconjunctivitis sicca"
dari bahasa Latin adalah "kekeringan kornea
dan konjungtiva".

Sindrom mata kering, atau

keratoconjunctivitis sicca (KCS) adalah
penyakit mata dimana jumlah atau kualitas
produksi air mata berkurang atau penguapan
film air mata meningkat.
 ETIOLOGI

Didapat Kongenital
Penyakit sistemik Ektropion atau
Sindrom sjorgen entropion
Hipertiroid
Aplasia kelenjar
Cedera lakrimal
Kerusakan kelenjar lakrimal (alakrima
Banyak terpapar radiasi kongenital)
Luka bakar kimiawi
Aplasia nervus
Obat trigeminus
Antihistamin
Antimuskarinik: atropin, skopolamin
Beta-adregenik blocker:

Neurogenik-neuroparalitik
Lagoftalmus

Avitaminosis A
ANATOMI
1. APPARATUS LAKRIMAL Glandula lakrimal
menerima pasokan
Kompleks lakrimalis terdiri atas glandula darah dari arteri
lakrimal, kanalikuli lakrimal, sakus lakrimal, lakrimalis
duktus nasolakrimal. Sistem lakrimal terdiri
atas 2 bagian, yaitu: dipersarafi oleh
Sistem produksi atau glandula lakrimal
Nervus lakrimalis
yang terletak di temporo antero superior (sensoris), sebuah
rongga orbita. cabang dari divisi
Sistem ekskresi, yang terdiri atas pungtum trigeminus.

lakrimal, kanalikuli lakrimal, sakus Nervus petrosus

lakrimal, duktus nasolakrimal. superfisialis magna
(sekretoris), yang
datang dari nukleus
salivarius superior.

Nervus simpatis yang

menyertai arteria
lakrimalis dan nervus
lakrimalis.
Film Air Mata
1. Lapisan superfisial (lipid)
- dihasilkan oleh kelenjar
meibom dan kelenjar
sebasea, berfungsi
mencegah evaporasi
2. Lapisan akueous (komponen
terbesar)
- disekresi oleh kelenjar
lakrimalis, glandula lakrimal
asesorius (kelenjar Krause
dan Wolfring),
3. Lapisan musin
- dihasilkan oleh selsel
goblet konjungtiva
Mekanisme Pengeluaran Air Mata
glandula lakrimal di anterior superolateral

pungtum lakrimal

kanalikuli lakrimal

sakus lakrimal

duktus nasolakrimal

interna meatus di rongga hidung

Patofisiologi
Penurunan kadar hormon
Reseptor androgen dan estrogen

Disfungsi kelenjar
Disfungsi kelenjar meibom akan berakibat
kehilangan lapisan lipid peningkatan evaporasi
meningkatkan produksi meibum memicu
penebalan serta sekresi air mata bersifat viskos
sehingga dapat mengobstruksi duktus dan
menyebabkan stagnasi dari sekresi
Reaksi inflamasi
Pelepasan interleukin 1 (IL-1), interleukin 6 (IL-6),
interleukin 8 (IL-8), TGF beta, TNF alpha

menimbulkan pelepasan opioid yang akan

mengikat reseptor opioid pada membran neural
dan menghambat pelepasan neurotransmitter

menghambat produksi cAMP dan fungsi neuronal

atrofi kelenjar lakrimalis

 MANIFESTASI KLINIS
Gejala Umum Tanda klinis
Perih pada bola mata
Permukaan bola mata terasa
Dilatasi vaskuler konjuntiva bulbi
seperti berpasir, seolah-olah
ada sesuatu yang mengganjal Penurunan meniskus air mata

di permukaan bola mata. Permukaan kornea yang ireguler

Belekan. Penurunan absorbsi air mata
Nyeri dan mata merah. Keratopati epitel kornea
Kelopak mata terasa berat. punctata
Ketidakmampuan Kornea berfilamen
mengeluarkan air mata saat Peningkatan debris pada lapisan
menangis.
air mata
Penurunan toleransi membaca,
Keratitis puntata superfisialis
bekerja menggunakan
komputer, atau setiap aktivitas Pada kasus berat, ulkus kornea
yang membutuhkan atensi
visual yang terus menerus.
Kelelahan mata
 DIAGNOSIS

Diagnosis bisa ditegakkan dengan anamnesis

berdasarkan keluhan pasien, pemeriksaan
fisik mata dengan slit lamp dan tes diagnostik:
1. Uji Schirmer
2. Tear Film Breakup Time (TBUT)
3. Uji Rose Bengal
Derajat Keparahan Mata Kering
Mild
Hasil tes schirmer kurang dari 10 mm dalam
5 menit

Moderate
Hasil tes schirmer antara 5-10 mm dalam 5
menit

Severe
Hasil tes schirmer kurang dari 5 mm dalam 5
menit,
KOMPLIKASI

Pada awal perjalanan keratokonjungtivitis sicca,

penglihatan sedikit terganggu.

Pada kasus lanjut, dapat timbul ulkus kornea,

penipisan kornea, dan perforasi. Kadang-
kadang terjadi infeksi bakteri sekunder, dan
berakibat timbulnya jaringan parut dan
vaskularisasi pada kornea, yang sangat
menurunkan penglihatan.
 PENATALAKSANAAN
Simptomatic treatment
Pengobatan sindrom mata kering adalah sebagai berikut
1. Pemberian air mata buatan
Air mata buatan diberikan 1-2 tetes pada dewasa maupun anak - anak
apabila terjadi defisiensi komponen air. Air mata buatan ini berfungsi sebagai
pelumas pada permukaan mata.

2. Salep / gel, sebagai pelumas jangka panjang, terutama saat tidur

3. Kacamata pelembab bilik

apabila penyebabnya lingkungan yang terlalu panas atau dingin. Usahakan
kaca mata hitam yang dipakai adalah yang mempunyai bentuk yang cukup
lebar dan menutupi daerah samping mata, sehingga penguapan air mata
dapat dihindari.

4. Agen anti-inflamasi
- Siklosporin A topikal : diberikan 1 tetes pada setiap mata per 12 jam.
- Kortikosteriod topikal : Kortikosteroid topikal baik digunakan sendiri atau
bersama dengan Siklosporin, bisa mengurangi peradangan dan gejala mata
kering.
 PENATALAKSANAAN
7. Bedah
- Punctal plug
- Tarsorrhaphy

Jika mengalami kesulitan menutup mata

 PROGNOSIS
Secara umum, prognosis untuk ketajaman
visual pada pasien dengan sindrom mata
kering adalah baik.

Sebagian besar pasien dengan derajat

keparahan ringan hingga sedang dapat
diobati gejalanya dengan pemberian
lubricant, dan gejalanya bisa teratasi.

Pada mata kering yang berat, bisa

mengganggu kualitas hidup karena seringkali
pasien mengeluhkan penglihatan kabur, iritasi
berat sehingga mereka kesulitan membuka
Journal

Prevalence of Diagnosed Dry

Eye Disease in the United
States Among Adults Aged
18 Years and Older
Purpose

To provide current estimates of the prevalence of

diagnosed dry eye disease (DED) and associated
demographics among US adults aged 18 years.

Design

Cross-sectional, population-based survey.

Methods

Data were analyzed from 75 000 participants in

the 2013 National Health and Wellness Survey to
estimate prevalence/risk of diagnosed DED
overall, and by age, sex, insurance, and other
demographic factors.
Background
Dry eye disease (DED) is a chronic disease of the
ocular surface that is widely encountered in
ophthalmic practice.
The womens The
health study physicians
(WHS) health studies I
estimated DED and II (PHS I
prevalence at and II)
DED quesioner
7.8% for estimated DED
women aged prevalence at
50 years 4.3% for men
(1999) aged 50
years (2004)
Most published estimated of DED prevalennce have focused on
older age group. However, there is an increasing clinical perception
that the prevalence of DED is growing and also that it is
increasingly occurring at younger ages
This study was designed to provide current
estimates of the prevalence of DED among the
adult population in the US, based on a large and
diverse study population.. specifically to estimate
the prevalence of diagnosed DED, and to inform
prevalence among younger age groups (1850
years).
METHODS
Study population
The study population was derived from the
2013 National Health and Wellness Survey
(NHWS) conducted by Kantar Health, USA.

The NHWS is an annual self-administered,

internet-based
questionnaire with a nation wide sample of 75
000 adults
(aged >18 years) in the US.
 Dry eye disease ascertainment
Participants were
asked whether
they had ever
experienced dry
Non-DED
eye. Possible
responses were
Yes or No.
Symptomat
ic
undiagnose
d
Diagnosed
DED
 Statistical analysis
compared categorical variables across groups
using the x2 test and continuous variables
using the 1-way analysis of variance (ANOVA)
F test and the Kruskal-Wallis rank sum test.
FIGURE 1. Comparison of age and sex distribution in the 2013
National Health and Wellness Survey (NHWS) with the US
adult population in the 2013 census.
RESULT
Study population

From the 75000

suvey
participants,
5051 reported a
diagnosis of DED
and 68160
reported no
experiance of DE
or non DED
 Dry Eye Disease Prevalence By Age And Sex
the overall prevalence of diagnosed DED
among US adults in 2013 was estimated at
6.8%
Women Men
(8.8%) (4.5%)

Prevalence of diagnosed DED increased

with age, ranging from 2.7% among those
aged 18-34 years to 18.6% among those
aged 75 years.
 Dry Eye Disease Prevalence By Age And Sex

FIGURE 2. Estimates of diagnosed dry eye disease

(Diagnosed-DED) prevalence by age and sex. CI
[ confidence interval.
 DRY EYE DISEASE PREVALENCE BY
DEMOGRAPHIC FACTORS
 Dry eye disease severity and diagnosis
characteristic
One half of all Diagnosed-DED participants
self-reported mild DED severity; 42% and 8%
reported moderate or severe DED,
respectively.
itching (60%)
symptoms were as follows:
gritty sensation (48%)

feeling of foreign body in eye (46%)

blurred vision (44%)

redness (42%)

light sensitivity (32%)

pain (19%)
DISCUSSION
Female sex and increased age, as suggested
by previous research, continue to be
significant risk factors for Diagnosed-DED.
Prevalence is nearly 2 times higher in women
than in men. For both sexes, prevalence
increases with age and is >3 times higher in
individuals aged >50 years.

Wome
n
Olds
 Based on an analysis of participants reported
data from the 2013 NWHS, estimated that
6.8% of the US adult population has diagnosis
of DED.
The Beaver The
The The beaver
Dam Veterans
Salisbury Dam
Offspring Affairs
Estimated Estimated Estimated Estimated
DED of DED at of DED at prevalenc
prevalenc 21.6% 14.6% e at 18.8%
e at 14.6% among among among
among individuals individuals those
individuals aged 48- aged 21- aged 21-
aged 65- 91 years 84 years 100 years
84 years
 This study found no difference in diagnosed
DED prevalence between Asian and white
participants. Asian population
has higher
Taiwanese Shihpai
meibomian gland
Study estimated
and poorer
prevalence of DED
blinking compare
at 33.7% of
with the white
individuals aged
population,
65 years
suggesting a
possible
(contrasts with
morphologic
this study)
predispotition of
DED
 This study did observe a higher risk of
diagnosied DED among hispanic participants
compare with non hispanic white participants
in US.
This study has also
US
moted a higher
vetera
prevalence of DED
ns
symptoms among
study
hispanic patiens.
Women in the
southern US had a
slightly higher risk of
WHS
DED compared with
those in the midwest
and northeast