MATA KERING

TELAAH ILMIAH
Oleh:
M. Rizqi Firyal, S.Ked
712016048

Pembimbing: dr. H. Ibrahim Sani, Sp.M

BAB I
Pendahuluan
Latar Belakang
• Permukaan mata  lapisan air mata, kornea,
epitel konjungtiva, meibomian, kelenjar
lakrimal, & kelopak mata.
• Lapisan air mata  lubrikan
▫ menjaga ketajaman mata
▫ melindungi kornea, & sel epitel konjungtival,
menjaga kelembaban keduanya
Latar Belakang
Penyakit mata kering:

• ADDE (Aqueous Deficient Dry Eye Disease)

▫ disfungsi/gangguan fungsi kelenjar lakrimalis
• EDE (Evaporative Dry Eye Disease).
▫ gangguan pada kelopak mata dan permukaan
mata (ocular surface)
• Bisa keduanya
BAB II
Tinjauan Pustaka
Tear Film (Lapisan Air Mata)
Pembentukan Lapisan Air Mata Saat
Berkedip
Definisi
• Dry eye disease (DED)
• Dry eye syndrome (DES)
• Keratoconjunctivitis sicca (KCS)
▫ penyakit multifaktorial
▫ dari air mata & permukaan okular
 ketidaknyamanan, gangguan penglihatan, &
ketidakstabilan air mata
 potensi kerusakan permukaan ocular.
Epidemiologi
• Perbedaan risiko (W>P) akan berkurang seiring
dengan peningkatan usia (> 65 tahun) menjadi
relatif sama antara wanita dan pria.
• Di Indonesia, prevalensi penyakit mata kering
sebesar 27,5% dan semakin meningkat pada
rentang umur lebih dari 60 tahun.
Faktor Risiko
• Usia lanjut
• Hormonal
• Penyakit sistemik
• Obat yang menurunkan produksi air mata
• Pemakai lensa kontak mata risiko iritasi
• Faktor lingkungan
• Mata yang menatap secara terus menerus
sehingga lupa berkedip
• Riwayat operasi refraktif
Klasifikasi
• ADDE (Aqueous Deficient Dry Eye Disease)
▫ disfungsi/gangguan fungsi kelenjar lakrimalis
• EDE (Evaporative Dry Eye Disease).
▫ gangguan pada kelopak mata dan permukaan
mata (ocular surface)
• Bisa keduanya
Gejala klinis
• Ocular burning
• Sensasi benda asing
• Nyeri
• Fotofobia
• Penglihatan kabur
Gejala Klinis
• Ringan  scratchiness, terbakar, atau menyengat,
dan pengaburan ringan ketika lapisan air mata
terganggu
• Sedang  ketidak nyamanan mata, dan ketajaman
mata secara visual terganggu
• Berat  keadaan mata kering semakin parah,
lapisan air mata cepat terputus, lapisan air mata
mengalami debris, kelopak mata terlihat lebih
meniskus, meningkatnya mukosa dalam air mata,
pewarnaan kornea dan konjungtiva, filament
mengalami keratitis dan kehilangan corneal cluster
Diagnosis
• Anamnesis
• Pemeriksaan Fisik/Mata
• Pemeriksaan Penunjang
General History

 Symptoms and signs (e.g., irritation, tearing, burning, stinging, dry or foreign body
sensation, mild itching, photophobia, blurry vision, contact lens intolerance, redness,
mucous discharge, increased frequency of blinking, eye fatigue, diurnal fluctuation,
symptoms that worsen later in the day)
 Exacerbating conditions (e.g., wind, air travel, decreased humidity, prolonged visual
efforts associated with decreased blink rate such as reading and using the computer)
 Duration of symptoms
Ocular History

 Topical medications and their associated preservatives (e.g., artificial tears, eyewash,
antihistamines, glaucoma medications, vasoconstrictors, corticosteroids, antiviral
medications, homeopathic or herbal preparations), which should be discussed and
considered
 Contact lens history
 Allergic conjunctivitis
 Ocular surgical history (e.g., prior keratoplasty, cataract surgery, keratorefractive
surgery)
 Ocular surface disease (e.g., HSV, varicella zoster virus, ocular mucous membrane
pemphigoid, aniridia)
 Punctal surgery
 Eyelid surgery (e.g., prior ptosis repair, blepharoplasty, entropion/ectropion repair)
 Bell’s palsy
Medical History

 Smoking or exposure to second-hand smoke

 Dermatological diseases (e.g., rosacea, psoriasis, varicella zoster virus)
 Technique and frequency of facial washing, including eyelid and eyelash hygiene
 Atopy
 Systemic inflammatory diseases (e.g., Sjögren syndrome, GVHD, rheumatoidarthritis, systemic lupus
erythematosus, Stevens-Johnson syndrome, sarcoidosis, scleroderma)
 Other systemic conditions (e.g., lymphoma, sarcoidosis)
 Systemic medications (e.g., antihistamines, diuretics, hormones and hormonalantagonists, antidepressants,
cardiac antiarrhythmic drugs, isotretinoin,diphenoxylate/atropine, beta-adrenergic antagonists, chemotherapy
agents, anyother drug with anticholinergic effects)
 Trauma (e.g., mechanical, chemical, thermal)
 Chronic viral infections (e.g., hepatitis C, HIV)
 Nonocular surgery (e.g., bone-marrow transplant, head and neck surgery, trigeminalneuralgia surgery)
 Orbital radiation
 Neurological conditions (e.g., Parkinson disease, Bell’s palsy, Riley-Day syndrome,trigeminal neuralgia)
 Nonocular symptoms: Dry mouth, dental cavities, oral ulcers, Fatigue, Joint pain/muscle ache, menopause
External Examination

 Skin (e.g., scleroderma, facial changes consistent with rosacea, seborrhea)

 Eyelids: incomplete closure/malposition, incomplete or infrequent blink, eyelid lag
or retraction, erythema of eyelid margins, abnormal deposits or secretions, entropion,
ectropion
 Adnexa: enlargement of the lacrimal glands
 Proptosis
 Cranial nerve function (e.g., cranial nerve V [trigeminal], cranial nerve VII [facial])
 Hands: joint deformities characteristic of rheumatoid arthritis, Raynaud
phenomenon, splinter hemorrhages underneath the nails
Slit Lamp Examination

 Tear film: height of the meniscus along the inferior eyelid, debris, increased
viscosity, mucous strands, and foam, break-up time and pattern
 Eyelashes: trichiasis, distichiasis, madarosis, deposits
 Anterior and posterior eyelid margins: abnormalities of meibomian glands (e.g.,
orifice metaplasia, reduced expressible meibum, atrophy), character of meibomian
gland secretions (e.g., turbid, thickened, foamy, deficient), vascularization crossing
the mucocutaneous junction, keratinization, scarring, eyelid margin hyperemia
 Puncta: patency and position, presence and position of plugs
 Conjunctiva:
o Inferior fornix and tarsal conjunctiva (e.g., mucous threads, scarring, erythema,
papillary reaction, follicle enlargement, keratinization, subepithelial fibrosis,
foreshortening, symblepharon)
o Bulbar conjunctiva (all four quadrants) (e.g., punctate staining with rose bengal,
lissamine green, or fluorescein dyes; hyperemia; localized drying; keratinization,
chemosis, chalasis, follicles). Lissamine green may provide higher yield in the
conjunctiva.
 Cornea: localized interpalpebral drying, punctate epithelial erosions assessed with
fluorescein dye, punctate staining with rose bengal or fluorescein dyes, filaments,
epithelial defects, basement membrane irregularities, mucous plaques, keratinization,
pannus formation, thinning, infiltrates, ulceration, scarring, neovascularization,
evidence of corneal or refractive surgery
Tes Schirmer
Tear break-up time (TBUT)
• Tear break-up time (TBUT) dilakukan untuk
menilai stabilitas lapisan air mata. Lapisan air
mata diberi pewarnaan fluoresin dan dilakukan
pemeriksaan kornea dengan menggunakan
lampu biru. Apabila interval waktu antara
mengedip dan terbentuknya dry spot pada
kornea kurang dari 10 detik dianggap abnormal
(nilai normal 15 detik).
Penatalaksanaan
Terapi Perlakuan
Lingkungan / Eksogen Edukasi dan modifikasi lingkungan
Mengeliminasi efek pengobatan topikal atau sistemik
Pengobatan topical Air mata buatan (artificial tears), gel/salep
Antiinflamasi (siklosporin dan kortikosteroid topikal)
Agen mukolitik
Serum autologous
Pengobatan sistemik Asam lemak omega 3 (dapat meningkatkan resiko kanker
prostat pada laki-laki)
Tetrasiklin (untuk disfungsi kelenjar meibomian, rosacea)
Antiinflamasi sistemik
Secretagogues
Penatalaksanaan
Terapi Perlakuan
Pembedahan Pemasangan sumbat punktum
Pemasangan sumbat punktum secara permanen
Penjahitan sepertiga kelopak mata (tarsorafi)
Perbaikan posisi kelopak mata
Selaput lendir, kelenjar saliva dan pencangkokan selaput
amniotic
Lainnya Terapi pada kelopak mata (kompres air hangat)
Kontak lensa
Kacamata moisture chamber
BAB III
PENUTUP
Simpulan
• Penyakit mata kering  Aqueous Deficient &
Evaporative
• Gejala klinis, (ringan, sedang, berat0
▫ Ocular burning, Sensasi benda asing, Nyeri,
Fotofobia, Penglihatan kabur
Simpulan
• Pada kasus ringan, pengobatan cukup dengan
artificial tears, kompres hangat dan massage
kelopak mata.

• Pada kasus berat, dapat dipertimbangkan

pemakaiaan kontak lensa, serum autologus,
terapi hormonal, siklosporin, oklusi pungtum
bahkan tindakan operasi.
TERIMA KASIH