Current Treatment Des

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CURRENT TREND IN MEDICAL TREATMENT OF DRY EYESYNDROME

Prof. DR.Dr. Rukiah Syawal, Sp.M (K)Bagian Ilmu Kesehatan MataFakultas KedokteranUniversitas HasanuddinMakassar

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WHAT IS DRY EYE ?

• N.E.I. (1993)

Dry Eye : Disorder of the tear film due to tear deficiency or excessive

evaporation which cause damage to the interpalpebral ocular surface and is

associated with symptoms of discomfort.

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• Foulks (2003)

Dry eye : A disturbance of the normal homeostatic interaction of the tear film and the ocular

surface.

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• Pflugfelder (2004)Dry eye : A disorder where by dysfunction

of the lacrimal function unit causes an unstable tear film which in turn promotion ocular surface inflammation,

epithelial disease and symptom of discomfort.

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• Dry Eye Workshop (DEWS) : 2007Dry eye : is a multifactorial disease of the tears

and ocular surface that results in symptoms of iscomfort, visual

disturbance and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface

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Normal tear film structure and components

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• Lacrimal Function Unit (LFU)→ an integrated system of :

♦ Lacrimal gland

♦ Ocular surface (cornea, conjunctiva)

♦ Palpebra and mebomian gland

♦ Sensory and motoric nerves

(nerv V1, nerv VII)

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• Neural pathways linking components of the lacrimal functional unit

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Disfunction of the lacrimal functional unit

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CLASSIFICATION OF DRY EYE

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MECHANISM OF DRY EYE

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RISK FACTORS

• Murube :

▪ Aging

▪ Hormonal

▪ Immunologi : autoimmun reaction

▪ Pharmacologic : topical, systemic

▪ Hyponutrition : vit.A deficiency, alcoholism

▪ Infection : HSK, trachoma

▪ Trauma : surgery

▪ Neurogenic : contact lens, post LASIK

▪ Defective gland

▪ Inability to utilize tears

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• DEWS : ● Aging

● Low androgen

● Drugs : systemic, topical

● Inflammatory lacrimal damage

● Refractive surgery

● Contact lens wear

● Environment

● Xerophthalmia

● Ocular allergy

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SYMPTOM OF DRY EYE

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SIGN OF DRY EYE

1. Conjunctival hyperemia2. Conjunctival pleating3. Decrease of corneal sensation4. Debris in the tear film5. Irregular corneal surface6. Epithelial keratopathy7. Filamentary keratopathy8. Visual loss

1. Conjunctival hyperemia2. Conjunctival pleating3. Decrease of corneal sensation4. Debris in the tear film5. Irregular corneal surface6. Epithelial keratopathy7. Filamentary keratopathy8. Visual loss

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CLINICAL STAGE (MURUBE)

I. (Mild)

→ itching, photophobia, foreign body sensation

NO SIGN OF TISSUE ALTERATION

II. (Moderate)

→ punctate erosion, epithelial ulcer, hyperemia of the exposure conjunctiva, decrease of corneal sensation.

III. (Severe)

~ severe decrease of corneal sensation

~ corneal leucoma, neovascularisation

~ retraction of the conjunctiva

~ loss of vision

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TREATMENT OF DRY EYE

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Recommended Treatment Dry Eye

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MEDICAL TREATMENT

1. Lubricate ocular surface→ ARTIFICIAL TEAR

2. Supress inflammation3. Minimize exposure4. Reduced tear evaporation5. Stimulate lacrimal tears6. Punctal occlusion

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ARTIFICIAL TEARS THE MAINSTAY OF TREATMENT DRY EYE SYNDROME

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ARTIFICIAL TEARS

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• ARTIFICIAL TEARS~ CELLULOSE DERIVATES

~ POLYVINYL DERIVATES

~ CLHONDROITIN SULFATE

~ SODIUM HYALURONATE

~ GLYCEROL

~ LIPID EMULSION (mineral oil)

CATIONORM

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• METHYL CELLULOSE

Advantages :

Disadventages : Viscosity

- Synthetic colloid, stable pH - High degree of uniformity - Less 1 % : refractive index = tear film - Emollient action

- Blurred vision - Agglutination of cilia - Retardant effect of corneal wound healing

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• POLYVINYL ALCOHOL

♦ Less viscous♦ Emollient properties♦ More adhesive to cornea♦ No adverse effect on regeneration corneal epithel♦ Resembling the mucin

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• SODIUM HYALURONATE 0,1%

- Glycosaminoglycan, found in synovial fluid, vitreous humor- Holding large quantities of water- Lubricant~ Chondroitin sulfate (Limberg, Nelson)- Very effective (Sand, Pollack)- Long residence time- Improvement of blurred vision and foreign body sensation

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CATIONORM

CATIONORM

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TERAPI TERAPI DRY EYEDRY EYE

Artificial tearsLubricants

DemulcentsLipid emulsions

Memperbaiki lapisan aquous

• Memperbaiki lapisan lipid

• Menghambat penguapan aquous

I. LIPID EMULSI

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II. CATIONIC→ CETALKONIUM CHLORIDE (CKC) 0,002%

Sel epitel di permukaan kornea & konjungtiva bermuatan negatif (anionik) Lebih mudah berikatan dengan larutan yang bermuatan listrik positif.

ELECTROSTATIC ATTRACTION

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• Electrostatic attractionElectrostatic attraction Comparison of neutral,

anionic, & cationic

eye drops

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• Emulsi kationik mempermudah penyebaran di seluruh permukaan mata

• Emulsi kationik memperpanjang waktu residensi di permukaan mata

• Efek terapi emulsi kationik lebih lama

Cationorm sebagai Emulsi Lipid Kationik

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III. NANODROPLET♦ Ukuran partikel minyak

yang nano, membuat

ukuran tetesan menjadi

lebih kecil dan lebih encer.

♦ Ukuran partikel yang sangat

kecil meningkatkan kenyamanan

pasien.

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Emulsi lipid Kationik Nanodroplet

Meningkatkan bioavailabilitas Meningkatkan waktu residensi

Rasa nyaman pada permukaan mata lebih lama

Frekuensi penggunaan lebih jarang; pasien lebih disiplin

Cationorm sebagai Emulsi Lipid Kationik Nanodroplet

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INDIKASI CATIONORM● Dry eye syndrome

♦ Dry eye tipe evaporasi

♦ Meibomian gland dysfunction (MGD)

♦ Dry eye akibat faktor lingkungan, penggunaan lensa kontak

♦ Dry eye pasca operasi (bedah refraktif,katarak)

● Cationorm dapat digunakan bersama dengan vitadrop atau air mata artifisial lainnya apabila dibutuhkan.

● Perhatikan jarak waktu antar penetesan

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• ARTIFICIAL TEAR

- Tonicity

- Retention time

- Adherence to ocular surface

CATIONORM HAVE A BETTER RESPONSE

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