Case Presentation

Dry Eye Syndrome

Okuli Sinistra

Baiq Regita Cahyami Surya

 Introduction

• Dry Eye Syndrome is disease water)eye and layer surface eye that
character multifactorial, with symptoms clinical form taste not
comfortable, distraction vision, and instability tear film potentially
spoil layer surface eye .
• Dry eye related with deficiency components tear film ( aqueous,
mucinosa, or lipid), abnormalities surface palpebra, or
abnormalities epithelium

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▫ Patient will complain itchy, eye as sandy, dazzled, and
sight run away.
▫ Prevalence eye dry to increase along with increase age.
Eyedry more often appear on woman especially woman
postmenopausal
▫ In Indonesia alone prevalence syndrome eye dry as
much 27.5%.

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▫ Diagnosis dry eye syndrome enforced through history
taking and examination physical eye that
comprehensive.
▫ Governance on patient with complaint dry eye that is
with therapy trial water eye artificial. Addition water
eye could done with giving drops eye or emulsion, gel,
and ointment

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 PATIENT IDENTITY
▫ Name : Mrs.. S
▫ Age : 50 years old
▫ Sex : Female
▫ Job: Farmer
▫ Religion : Islam
▫ Address : Dusun Pohdodol, Bajur Labuapi
▫ Date Examination : Tuesday , 16 March 2021
▫ Number Record Medical : 028303

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1. ANAMNESIS
 Complaint Main :
Itchy and sore on eye left

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 Current Disease History
▫ Patient come to Mataram University hospital with
complaint eye left that feels itchy and sore.
▫ Patient complaint the felt since ± 2 month that then
and long too long the more heavy.
▫ Patient feel as there is that wedge on his eyes, that is as
sand that stick to on his eyes

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▫ Patient feel too his eyes feels sore and hot when look light
especially noon approaching afternoon when patient
moderate pick vegetable or work in rice fields.
▫ Patient says his left eye feels more run away compared that
right too
▫ Factor that aggravate complaint not is known. Factor that
lighten up complaint that felt is when patient drip drops eye
that purchased in store.
▫ Patient too feel of late this often feel dizzy

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Past medical history Family History of Illness
▫ No similar problem ▫ No similar problem
▫ Not wearing glasses ▫ Diabetes mellitus and
hypertension (-)
▫ Diabetes mellitus and
hypertension (-)

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History Treatment History Allergy

▫ Muse drug drops eye that ▫ Patient not have history

purchased in store to allergy drug or even food.
resolve complaint on eye
patient

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History Social

▫ Patient work as a the farmer and in work patient not

use protector as spectacles or even hat. Patient confess
already not menstruation since ± 6 month then.

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Physical Examination

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General Condition Good
Consciousness/GCS Compos mentis
Vital Sign
Blood Pressure 120/80 mmHg
RR 90 x/minute
HR 20 x/minute
Temperature 36,6º C

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 OD OS
Visus
6/6 6/7 ph 6/6
Ocular Alignment

Hirschbeg Ortoforia Ortoforia

Cover Uncover Test Ortotropia Ortotropia

Extraocular Motility

- Good in all direction - Good in all direction

- Pain (-) - Pain (-)
- Diplopia (-) - Diplopia (-)

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 OD OS
Visual Fields

Same as the examiner

Same as the examiner
Silia Clean, no secret, growth direction Clean, no secret, growth direction
normal normal
Superior and Inferior Mass (-), Ectropion (-), Entropion (- Mass (-), Ectropion (-), Entropion (-),
Palpebra ), Hyperemia (-), Mass (-), Ptosis (-), Hyperemia (-), Mass (-), Ptosis (-),
Lagophtalmos (-) Lagophtalmos (-)

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 OD OS
Superior and Inferior Palpebra Hyperemia (-), Secret (-), Hyperemia (-), Secret (-),
Conjungtiva Folicel (-) Folicel (-)
Bulbar Conjungtiva Conjungtival and siliar Conjungtival and siliar
injection (-) injection (-)
Hyperemic (+) Hyperemic (-)
Edema (-) Edema (-)
Mass: (-) Mass: (-)

Lacrimal Punctum Edema, wound, obstruction (-) Edema, wound, obstruction (-)

Lacrimal Saccus Edema, wound, mass (-) Edema, wound, mass (-)

Lacrimal gland Mass (-) Mass (-)

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 OD OS
Cornea Shape convex Shape convex
Transparancy not clear Transparancy not clear
Surface not smooth Surface not smooth
Arcus senilis Arcus senilis
COA Deep Deep
Hifema (-) Hifema (-)
Hipopion (-) Hipopion (-)
Iris Color: brown Color: brown
Shape: round and regular Shape: round and regular
Pupil Round, regular, 3 mm Round, regular, 3 mm
DLR (+) / IDLR (+) DLR (+) / IDLR (+)
Lens Clear Clear
TIO Normal per palpation Normal per palpation
Fundoscopy Red reflex (+) (+)Red reflex

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DISCUSSION & CLINICAL
REASONING
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 Identification Problem
Subjective
▫ Patient complained eye itchy and sore since 2 month then.
▫ Patient feel is there taste wedge on second eye as sandy on eye so
that patient often rub his eyes.
▫ Patient feel sick and hot when look light.
▫ Eye left feels more run away compared eye right.
▫ Patient already not menstruation since ± 6 month then

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Objective
▫ Visus naturalist OD 6/6 and
OS 6/7 ph 6/6
▫ On examination cornea
right and sinistra obtained
turbidity on area limbus
(arcus senile)
▫ Foamy tears

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CASE ANALYSIS

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▫ Patient come with complaint eye itchy and sore on eye his
left. Complaint the presumed because dry eye syndrome
▫ Water eye forming layer thin thick 7-10 µm which is cover
epithelium cornea and visitation.
▫ The structure of layer is on mucus layered deepest, aquos
layered the middle, and fat layered outermost

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 Layer-layer water film eye
Lipid Akueosa Musin
Layer superficial is lipid Degenerated by Consist on glycoproteins and coat
film monomolecular that gland lacrimal cells epithelialcornea and
originated from gland major and conjunctiva. Membrane cell
meibom. Presumed layer epithelium composed on lipoproteins
minor; contain
this hinder evaporation and therefore relatively hydrophobic.
substance late-
and forming barrier Musin adsorbed in part on membrane
water (salt and cell epithelium cornea and by
impermeable-water protein). microvilli tethered on cells
moment palpebra closed. epithelium surface

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▫ The function of Water eye is to lubrication, Secrete or
"rinse" object foreign in eye, and reduce risk infection
▫ Curtain water eye that healthy depends on function unit
lacrimal optimal, and composed on layer surface eye (
cornea, conjunctiva, gland lacrimal accessory and gland
meibom), gland lacrimal main and innervation
interconnection
▫ Dysfunction components this could cause eye dry

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Risk Factor

▫ Old age, woman, therapy estrogen post monopause,

intake omega 3 ones low, drugs anti histamine,
connective-tissue disease, surgery LASIK and
refractive excimerlaser, therapy radiation, transplant
hematopoietic stem cell, deficiency vitamin A,
infection hepatitis C, deficiency androgens, cigarette,
coffee

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▫ Age have factor risk to incident dry eye syndrome, the more to
increase age the more to increase also risk exposed dry eye
syndrome
▫ In America 4,8 million population aged ≥ 50 year suffer dry eye
syndrome. Presearch other say dry eye syndrome the highest are
located on range age 31-40 year amounting to 20%.
▫ Patient dry eye syndrome on range age can only varies, Thing this
caused by factor other as demographic, type profession, or exposure
to environment as exposure to sun, wind, or temperature that high.

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▫ Prevalence type sex the most is girls because drop
secretions water eye the result the low estrogen on
woman menopause.
▫ Profession patient as the farmer oblige patient more
often have activities outside exposed with sun, wind or
temperature that high

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▫ Thing the happen because condition environment with
level humidity that less and height Genre air will
Upgrade evaporation tear film so that water eye are
located on circumstances hyperosmolaris and ended
on condition instability layer lipids from tear film.

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▫ On examination physical obtained drop vision on eye left
patient, that is then getting better when usepinhole.
Fromexamination conjunctiva palpebra inferior got it is there
foamy tears on eye left patient. Besides that obtained also
adanya arcus senile on second cornea eye patient
▫ Drops eye that could given that is carboxymethylcellulose or
sodium hyaluronic.

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Assessment

▫ Diagnosis work : Dry Eye

Syndrome Okuli Sinistra

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 DIAGNOSIS OF APPEAL

Blefaritis Posterior Keratoconjunctivitis atopy

▫ Inflammation secondary petals ▫ Disease this caused
eye that happen the result because hypersensitivity
dysfunction or distraction type IV, and generally
spending secret gland meibom obtained on age adult that
and gland zeis is 30-50 year.

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Planning Diagnostic

▫ Calculation symptoms eye dry could done in a manner

objective with use ocular surface disease index (OSDI)
▫ Examination Schirmer Test to enforce diagnostic and
find out production water eye patient
▫ Examination with slit lamp to demand level eye dry.

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 Planning Therapy

▫ Therapy Medical
⬝ Giving water eye artificial ( cendo lyteers 4 times drops in 1
day on eye left)
▫ Therapy surgery
⬝ Installer blockage in punctum that character temporary
(collagen), or to time that more long ( silicon ) action this to
hold back secret water eye.

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 Counseling, Information, and Education Patient

▫ Explain related with condition patient moment this, family

and patient must knowing that eye dry is circumstances
chronic and recovery total hard happen, except on case
light, moment change epithelium on cornea and
conjunctiva still reversible.

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Prognosis

▫ Ad vitam (prognosis life) : Bonam

▫ Ad functionam (prognosis vision): Dubia ad Bonam
▫ Ad sanationam (prognosis get well): Dubia ad Bonam

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 CONCLUSION
▫ Patient girls aged 50 year come to RS Unram with complaint vision run away
on eye left felt since ± 2 month that then and long too long the more heavy.
Patient complained his eyes feels itchy and sore on next left. Besides that
patient too feel his eyes feels wedge, as there is sand that there is in eye
patient. Patient too complained his eyes feels pain or not comfortable when
look light. On examination physical obtained vision eye right 6/6, eye left 6/7
ph 6/6. On examination conjunctiva inferior obtained foamy tears and on
cornea obtained is there arcus senile. Patient in diagnosis with dry eye
syndrome. Plan therapy that will given is giving drops eye artificial.

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 Bibliography

▫ Sitompul R, Sitorus RS, Widyawati S, et al. Buku Ajar Oftalmologi. Jakarta: Badan Penerbit FKUI, 2017
▫ Ilyas, S., Tansil, M., dan Salamun, ZA. Sari Ilmu Penyakit Mata. Jakarta : Bala Penerbit FK UI. 2000
▫ Syuhada R., Syahputra M.W. PENGARUH PRODUKSI AIR MATA TERHADAP DRY EYE SYNDROME
PADA PASIEN DI POLIKLINIK MATA RUMAH SAKIT PERTAMINA BINTANG AMIN BANDAR
LAMPUNG TAHUN 2018. Jurnal Ilmu Kedokteran Dan Kesehatan. Volume 5 Nomor 3. Hal 218-223 .
2018
▫ Vaughan, D.G., Asbury, T. Ophtalmology Umum. ED. 14. Jakarta : EGC. 2009
▫ Septivianti R., Triningrat A.A.M.P. Karakteristik pasien dry eye syndrome di Desa Tianyar Timur,
Kecamatan Kubu, Kabupaten Karangasem. E-JURNAL MEDIKA UDAYANA. VOL. 7 NO. 3,. Hal 113 –
116
▫ Ikatan dokter Indonesia. Panduan Praktik Klinis Bagi Dokter Di Fasilitas Pelayanan Kesehatan Primer.
2014.

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 THANKS!
Any questions?

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