KARYA TULIS AKHIR

HUBUNGAN LAMA PAPARAN ASAP KENDARAAN BERMOTOR

TERHADAP DERAJAT KELUHAN DRY EYE SYNDROME PADA POLISI

LALU LINTAS DI KOTA MALANG

Oleh:

Yolanda Alifvichasari

201510330311103

UNIVERSITAS MUHAMMADIYAH MALANG

FAKULTAS KEDOKTERAN

2019

ii

HASIL PENELITIAN

HUBUNGAN LAMA PAPARAN ASAP KENDARAAN BERMOTOR

TERHADAP DERAJAT KELUHAN DRY EYE SYNDROME PADA POLISI

LALU LINTAS DI KOTA MALANG

KARYA TULIS AKHIR

Diajukan kepada

Universitas Muhammadiyah Malang

untuk Memenuhi Salah Satu Persyaratan

dalam Menyelesaikan Program Sarjana

Fakultas Kedokteran

Oleh:

Yolanda Alifvichasari

201510330311103

FAKULTAS KEDOKTERAN

UNIVERSITAS MUHAMMADIYAH MALANG

2019

iii

iv

vi

KATA PENGANTAR

Puji syukur kehadirat Allah SWT karena atas rahmat dan hidayah-Nya,

penulisan tugas akhir ini dapat diselesaikan dengan baik dan tepat waktu.

Shalawat serta salam selalu tercurahkan kepada Rasulullah Muhammad

Shalallahu Alaihi Wasallam, keluarga, para sahabat, dan pengikut beliau yang

telah membawa dunia ini dari zaman kegelapan menuju zaman terang –

benderang.

Penelitian tugas akhir ini berjudul “Hubungan Lama Paparan Asap

Kendaraan Bermotor terhadap Derajat Keluhan Dry Eye Syndrome pada Polisi

Lalu Lintas di Kota Malang “. Tugas akhir ini diajukan untuk memenuhi

persyaratan Pendidikan Sarjana Fakultas Kedokteran Universitas Muhammadiyah

Malang.

Penulis menyadari tugas akhir ini masih jauh dari kata sempurna, oleh

karena itu, penulis sangat mengharapkan saran dan masukan yang membangun.

Semoga karya tulis ini dapat menambah wawasan keilmuan dan bermanfaat bagi

semua pihak.

Wassalamu’alaikum Warahmatullah Wabarakatuh.

Malang, 8 Agustus 2019

vii

Penulis

UCAPAN TERIMA KASIH

Pada kesempatan ini penulis ingin menyampaikan terimakasih yang

sebesar-besarnya kepada:

1. Allah SWT yang telah selalu memberikan karunia dan keajaiban-Nya

sehingga penulis dapat menyusun dan menyelesaikan tugas akhir ini.

2. Secara khusus penulis ingin mengucapkan terimakasih kepada papa saya

tercinta Darto Suwito dan ibu yang saya sayangi Endang Sulis Setyowati

serta kepada adik-adik saya Girosa Dwi Nurcahyo dan Maura Cinthia

Lena yang telah memberikan dukungan Do’a dan pengorbanan baik moril

maupun material sehingga penulis dapat menyelesaikan tugas akhir ini.

3. Dr.dr.Meddy Setiawan, Sp.PD, FINASIM selaku dekan Fakultas

Kedokteran Universitas Muhammadiyah Malang atas bimbingannya

selama di FK UMM.

4. dr. Bragastio Sidharta, M.Sc, Sp.M sebagai pembimbing 1 dan juga dr.

Feny Tunjugsari, M.Kes selaku pembimbing 2 yang telah membimbing

penulis dan memberi masukan serta waktu, pikiran dan perhatian kepada

penulis selama proses penyusunan tugas akhir ini hingga akhir.

5. dr. Rubayat Indradi, MOH selaku dosen penguji yang telah memberikan

kritik dan saran yang membangun untuk kebaikan tugas akhir ini.

6. Segenap dosen pengajar di Fakultas Kedokteran Universitas

Muhammadiyah Malang yang telah memberi ilmu serta pengalaman

selama perkuliahan.

viii

7. MEARS (Medical and Health Research) Fakultas Kedokteran Universitas

Muhammadiyah Malang., dr. Anung Putri Illahika selaku pembimbing

komisi ilmiah saya.

8. Segenap staf tata usaha Fakultas Kedoteran Universitas Muhammadiyah

Malang yang telah membantu setiap proses demi kelancaran tugas akhir

ini.

9. Teman-teman belajar saya Regita Liony , Hen Sania, Asti Yumna dan

Naswa Arvieda yang memberikan semangat serta dukungan untuk segera

menyelesaikan tugas akhir ini.

10. Andika Dewa Satrio yang selalu menemani dan memberikan dukungan

serta semangat kepada saya

11. Teman-teman METACARPAL terima kasih atas kebersamaan selama ini.

12. Semua pihak yang telah membantu secara langsung maupun tidak

langsung, yang tidak bisa disebutkan satu persatu.

Hanya ucapan terima kasih dan doa yang dapat penulis sampaikan atas

segala kebaikan tiada henti dan dukungan yang telah diberikan. Semoga

segala kebaikan yang diberikan kepada penulis mendapat balasan baik dari

Allah SWT dan semoga tugas akhir ini dapat bermanfaat bagi pembaca dan

dapat digunakan untuk menyempurnakan karya-karya selanjutnya.

Wassalamu’alaikum Warahmatullahi Wabarakatuh

Malang, 8 Agustus 2019

Penulis

ix

ABSTRAK

Alifvichasari, Yolanda, 2019. Hubungan Lama Paparan Asap KendaraanBermotor terhadap Derajat Keluhan Dry Eye Syndrome pada PolisiLalu Lintas di Kota Malang. Tugas Akhir, Fakultas KedokteranUniversitas Muhammadiyah Malang. Pembimbing: (I) BragastioSidharta* (II) Feny Tunjungsari**

Latar Belakang: Dry eye syndrome (DES) merupakan penyakit multifaktorialpermukaan okular ditandai dengan hilangnya homeostasis dari tear film dandisertai gejala okular. Durasi lama paparan asap kendaaran terhadap polisi lalulintas mempengaruhi derajat keparahan pada DES. Polusi udara terakumulasipada permukaan okular selama bertahun-tahun sampai gejala mulai muncul.

Tujuan: Untuk mengetahui hubungan lama paparan asap kendaraan bermotorterhadap derajat keluhan DES pada polisi lalu lintas di kota Malang.

Metode Penelitian: Observasi analitik dengan pendekatan cross sectional.Sampel berjumlah 62 sampel laki-laki yang bekerja di lapangan. Uji hipotesisyang digunakan adalah chi-square, namun karena expected count >20% makamemakai uji Kruskal Wallis dan Mann Whitney. Uji regresi ordinal untukmengetahui faktor yang berpengaruh signifikan terhadap DES.

Hasil Penelitian: Uji Kruskal Wallis didapatkan hubungan signifikan antaralama paparan asap kendaran pada peningkatan derajat keluhan DES (p<0,05). UjiMann Whitney didapatkan hubungan yang signifikan pada kelompok lamapaparan <5 tahun dengan kelompok >10 tahun dan kelompok lama paparan 5–10tahun dengan kelompok >10 tahun (p<0,05). Uji regresi ordinal didapatkan faktoryang signifikan menyebabkan DES yaitu faktor usia (OR = 1,289) dibandingkandengan faktor lama paparan asap kendaraan bermotor (OR = 0,664).

Kesimpulan: Lama paparan asap kendaraan bermotor berhubungan denganpeningkatan derajat keluhan DES, tetapi pengaruhnya tidak lebih besar daripadafaktor usia pada polisi lalu lintas di Kota Malang.

Kata kunci : Lama paparan, asap kendaraan, derajat keluhan, dry eye syndrome

*) Staff pengajar Fakultas Kedokteran, Universitas Muhammadiyah Malang.**)Staff pengajar Fakultas Kedokteran Universitas Muhammadiyah Malang

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ABSTRACT

Alifvichasari, Yolanda, 2019. Correlation of The Duration of Gas EmissionExposure with the Illness Degree of Dry Eye Syndrome on TrafficPoliceman in Malang City. Final Assignment, Medical Faculty ofUniversity of Muhammadiyah Malang. Advisors: (I)BragastioSidharta*, (II)Feny Tunjungsari**

Background: Dry eye syndrome (DES) is a multifactorial illness of ocularsurface marked by the loss of tear film homeostasis followed by ocularsymptoms. Duration of gas emission exposure on traffic policeman in Malang hasan effect with the illness degree of DES. Air pollution accumulated on ocularsurface for years until the symptoms showed up.

Objective: To find out the correlation between the duration of gas emissionexposure with the illness degree of DES on traffic policeman in Malang.

Methods: Analytic observational with cross-sectional approach. Sample used inthis research are 62 male of traffic policeman that has a duty on field. Hypothesistest used is chi-square, but since the expected count was >20% then KruskalWallis and Mann Whitney are used. Multivariate ordinal regression used to findout the most significant factor on DES.

Result: Kruskal Wallis test revealed that there is a significant correlationbetween the duration of gas emission exposure towards the illness degree of DES(p<0,05). Mann Whitney test revealed that there is significant correlation(p<0,05) between <5 years exposed group and >10 years exposed group also 5-10years exposed group and >10 years. Multivariate ordinal regression showed thatthe significant cause of DES was the age factor (OR = 1,289) compared to theduration of gas emission exposure factor (OR = 0,664).

Conclusion: The duration of gas emission exposure has a correlation with theillness degree of DES, but the effect less than the age factor on traffic policemanin Malang.

Keyword: exposure duration, gas emission, degree of illness, dry eye syndrome

*Lecturer of Faculty of Medicine, University of Muhammadiyah Malang

**)Lecturer of Faculty of Medicine, University of Muhammadiyah Malang

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DAFTAR ISI

HASIL PENELITIAN....................................................................................................... ii

LEMBAR PENGESAHAN .............................................................................................iii

PERNYATAAN ORISINALITAS .................................................................................. iv

LEMBAR PENGUJIAN ................................................................................................... v

KATA PENGANTAR ....................................................................................................vi

UCAPAN TERIMAKASIH............................................................................................vii

ABSTRAK ....................................................................................................................... ix

ABSTRACT........................................................................................................................ x

DAFTAR ISI.................................................................................................................... xi

DAFTAR TABEL.........................................................................................................xvii

DAFTAR GAMBAR ...................................................................................................xviii

DAFTAR SINGKATAN ............................................................................................... xix

DAFTAR LAMPIRAN..................................................................................................xxi

BAB 1 PENDAHULUAN ............................................................................................... 1

1.1 Latar Belakang ............................................................................................. 1

1.2 Rumusan Masalah ........................................................................................ 3

1.3 Tujuan ........................................................................................................... 3

1.3.1 Tujuan Umum ....................................................................................... 3

1.3.2 Tujuan Khusus....................................................................................... 3

1.4 Manfaat ........................................................................................................ 4

1.4.1 Manfaat Akademik................................................................................ 4

xii

1.4.2 Manfaat Instansi .................................................................................... 4

1.4.3 Manfaat Masyarakat .............................................................................. 4

BAB 2 TINJAUAN PUSTAKA ...................................................................................... 5

2.1 Aparatus Lakrimalis...................................................................................... 5

2.1.1 Kelenjar Lakrimalis............................................................................... 5

2.1.2 Kelenjar Lakrimal Aksesori .................................................................. 6

2,1.2.1 Kelenjar Krause .......................................................................... 6

2.1.2.2 Kelenjar Wolfring........................................................................ 6

2.1.3 Vaskularisasi dan Inervasi Kelenjar Lakrimal..................................... 6

2.2 Jalur Lakrimal .............................................................................................. 7

2.2.1 Punkta Lakrimalis ................................................................................. 7

2.2.2 Kanalikuli Lakrimalis............................................................................ 7

2.2.3 Sakus/Kantung Lakrimalis ................................................................... 7

2.2.4 Duktus/Saluran Nasolakrimalis............................................................. 8

2.3 Tear Film ...................................................................................................... 9

2.3.1 Struktur Tear Film (Lapisan Air Mata)................................................. 9

2.3.2 Fungsi Tear Film ................................................................................ 11

2.3.3 Sekresi Air Mata.................................................................................. 11

2.3.4 Eliminasi Air Mata .............................................................................. 12

2.3.5 Osmolaritas Air Mata .......................................................................... 14

2.4 Dry Eye Syndrome ...................................................................................... 14

2.4.1 Definisi ................................................................................................ 14

xiii

2.4.2 Epidemiologi ....................................................................................... 14

2.4.3 Klasifikasi............................................................................................ 16

2.4.3.1 Mata Kering Defisiensi Aqueous (MKDA)............................... 16

2.4.3.2 Evaporasi/Penguapan Berlebihan.............................................. 17

2.4.4 Faktor Risiko ....................................................................................... 18

2.4.4.1 Usia ........................................................................................... 18

2.4.4.2 Kondisi Lingkungan.................................................................. 18

2.4.4.3 Pekerjaan ................................................................................... 19

2.4.4.4 Nutrisi........................................................................................ 19

2.4.4.5 Status Hormonal........................................................................ 19

2.4.4.6 Obat-Obatan Sistemik ............................................................... 20

2.4.4.7 Obat Mata Topikal .................................................................... 20

2.4.4.8 Penggunaan Lensa Kontak........................................................ 21

2.4.4.9 Operasi Refraktif ....................................................................... 21

2.4.5 Mekanisme .......................................................................................... 22

2.4.6 Gejala .................................................................................................. 24

2.4.7 Derajat Dry Eye Syndrome .................................................................. 25

2.4.8 Komplikasi ......................................................................................... 27

2.5 OSDI (Ocular Surface Disease Index) ....................................................... 27

2.5.1 Derajat Keluhan OSDI (Ocular Surface Disease Index) .................... 27

2.5.2 Penilaian Dry Eye Syndrome............................................................... 29

xiv

2.6 Asap Kendaraan ......................................................................................... 30

2.6.1 Komposisi dan Perilaku Gas Buang Kendaraan Bermotor...................... 30

2.6.2 Senyawa Kimia Dalam Gas buang Kendaraan ........................................ 31

2.6.2.1 CO (Karbon Monoksida) ............................................................... 31

2.6.2.2 NO (Nitrogen Oksid a) .................................................................. 32

2.6.2.3 HC (Hidro Karbon) ........................................................................ 33

2.6.2.4 CO2 (Karbon Dioksida) ................................................................. 33

2.6.2.5 SOx (Oksida Belerang) .................................................................. 33

2.6.2.6 PM10 (Particulate Matter).............................................................. 34

2.7 Dampak Asap Kendaraan dan Dry Eye Syndrome ..................................... 35

BAB 3 KERANGKA KONSEP DAN HIPOTESIS....................................................... 37

3.1 Kerangka Konsep........................................................................................ 37

3.2 Hipotesis ..................................................................................................... 38

BAB 4 METODE PENELITIAN.................................................................................... 39

4.1 Jenis Penelitian............................................................................................ 39

4.2 Lokasi dan Waktu Penelitian ...................................................................... 39

4.2.1 Lokasi .................................................................................................. 39

4.2.2 Waktu Penelitian ................................................................................. 39

4.3 Populasi dan Sampel ................................................................................... 39

xv

4.3.1 Populasi ............................................................................................... 39

4.3.2 Sampel................................................................................................. 39

4.3.3 Besar Sampel....................................................................................... 40

4.4 Karakteristik Sampel Penelitian.................................................................. 40

4.4.1 Kriteria Inklusi ................................................................................... 40

4.4.2 Kriteria Eksklusi ................................................................................. 40

4.5 Variabel Penelitian...................................................................................... 41

4.5.1 Variabel Bebas .................................................................................... 41

4.5.2 Variabel Terikat................................................................................... 41

4.6 Definisi Operasional .................................................................................. 41

4.7 Metode Pengumpulan Data......................................................................... 42

4.8 Alur Penelitian ........................................................................................... 42

4.9 Analisis Data............................................................................................... 43

BAB 5 HASIL PENELITIAN ........................................................................................ 44

5.1 Data Umum Demografi Responden............................................................ 44

5.2 Analisis Data............................................................................................... 48

5.2.1 Hasil Uji Chi-Square .......................................................................... 48

5.2.2 Hasil Uji Kruskal Wallis..................................................................... 48

5.2.3 Hasil Uji Mann Whitney..................................................................... 49

xvi

5.2.4 Hasil Uji Regresi Ordinal ................................................................... 50

5.2.5 Hasil Uji Odds Rasio .......................................................................... 50

BAB 6 PEMBAHASAN................................................................................................. 52

BAB 7 KESIMPULAN DAN SARAN .......................................................................... 58

7.1 Kesimpulan ................................................................................................. 58

7.2 Saran ........................................................................................................... 58

7.2.1 Bagi Petugas Kesehatan ...................................................................... 59

7.2.2 Bagi Instansi ........................................................................................ 59

7.2.3 Bagi Masyarakat.................................................................................. 59

7.2.4 Bagi Peneliti Selanjutnya .................................................................... 60

DAFTAR PUSTAKA ..................................................................................................... 61

xvii

DAFTAR TABEL

Tabel 2.1 Derajat Dry Eye Syndrome.............................................................................. 25

Tabel 2.2 Derajat Keluhan OSDI (Ocular Surface Disease Index) ................................ 27

Tabel 4.1 Definisi Operasional ....................................................................................... 41

Tabel 5.1 Distribusi Umum Demografi Responden........................................................ 44

Tabel 5.2 Prevalensi Kejadian Dry Eye Syndrome ......................................................... 46

Tabel 5.3 Karakteristik Penderita Dry Eye Syndrome .................................................... 46

Tabel 5.4 Hasil Tabulasi Silang ...................................................................................... 47

Tabel 5.5 Hasil Uji Kruskal Wallis ................................................................................. 48

Tabel 5.6 Uji Mann Whitney Berdasarkan Lama Paparan ............................................. 48

Tabel 5.7 Hasil Uji Wald ................................................................................................ 50

Tabel 5.8 Koefisien Determinasi..................................................................................... 50

xviii

DAFTAR GAMBAR

Gambar 2.1 Anatomi Aparatus Lakrimalis ....................................................................... 8

Gambar 2.2 Struktur Tear Film....................................................................................... 10

Gambar 2.3 Mekanisme Pompa Lakrimal ...................................................................... 13

Gambar 2.4 Mekanisme Mata Kering ............................................................................ 22

Gambar 2.5 Evaluasi Skor OSDI .................................................................................... 29

Gambar 5.1 Diagram Distribusi Usia Responden ........................................................... 45

Gambar 5.2 Diagram Distribusi Lama Paparan Responden ........................................... 46

Gambar 5.3 Diagram Distribusi Derajat Keluhan Dry Eye Syndrome Responden......... 46

Gambar 5.4 Diagram Angka Kejadian Dry Eye Syndrome Responden.......................... 47

xix

DAFTAR SINGKATAN

AIDS : Acquired Immune Deficiency Syndrome

BPLH : Badan Pengelola Lingkungan Hidup

CO : Karbon monoksida

DEWS : Dry Eye Work Shop

DKI : Daerah Khusus Ibukota

DM : Diabetes Melitus

GVHD : Graft vs Host Disease

H2SO4 : asam sulfat

ISPA : Infeksi Saluran Penafasan Akut

LASIK : Laser-assisted in situ keratomileusis

MAP : Mitogen-Activated Protein

MGD : Penyakit kelenjar Meibomian

MKDA : Mata Kering Defisiensi Aqueous

M3 : Muscarinic 3

NF-kß : Nuclear Factor Kappa-B

NLD : Duktus nasolakrimal

NO2 : Nitrogen dioksida

OSDI : Ocular Surface Disease Index

O3 : Ozon

Pb : Timbal

PM : Particulate Matter

xx

RPM : Respirable Particulate Matter

SO2 : Sulfur dioksida

SO3 : Sulfur trioksida

TBUT : Tear Break Up Time

TNF-α : Tumor Nekrosis Factor – alpha

WHO : World Health Organization

xxi

DAFTAR LAMPIRAN

Lampiran 1. INFORM CONSENT................................................................................... 66

Lampiran 2. LEMBAR PERSETUJUAN....................................................................... 71

Lampiran 3. IDENTITAS RESPONDEN....................................................................... 72

Lampiran 4. KUESIONER OCULAR SURFACE INDEX DISEASE (OSDI) ................ 73

Lampiran 5. HASIL ANALISIS DATA UJI STATISTIK ............................................. 76

Lampiran 6. DOKUMENTASI PENELITIAN .............................................................. 82

Lampiran 7. SURAT KETERANGAN LOLOS KAJI ILMIAH LAPORAN HASIL

PENELITIAN ................................................................................................................. 83

Lampiran 8. CONTOH PENGISIAN KUESIONER OLEH RESPONDEN.................. 84

Lampiran 9. SURAT KETERANGAN TELAH MELAKUKAN PENELITIAN.......... 86

Lampiran 10. HASIL DETEKSI PLAGIASI ................................................................. 87

Lampiran 11. KARTU KONSULTASI TUGAS AKHIR .............................................. 88

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DAFTAR PUSTAKA

Arikunto S. 2006. Prosedur Penelitian Suatu Pendekatan Praktek. Rineka Cipta:

Jakarta. P. 118.

Badan Pengelolaan Lingkungan Hidup Daerah Jakarta. 2013. Pengertian

Pencemaran Udara: Jakarta. (https://lingkunganhidup.jakarta.go.id/)

Basak, Samar Kumar. 2018. Prefereed Practice Pattern: Dry Eye Disease. India:

AIOS.

Basuki, K.T. 2007. Penurunan Konsentrasi Co dan NO2 Pada Emisi Gas Buang

Dengan Menggunakan Media Penyisipan TiO2 Lokal Pada Karbon Aktif.

Jurnal Sains Teknologi, Vol 1, No 1, pp. 9-10.

Craig, Jennifer P., et al. 2017. TFOS DEWS II definition and classification

report. The Ocular Surface, Vol 15, No. 3, pp. 276-283.

Dry Eye Workshop. 2007. The Definition and Classification Subcommittee of the

International Dry Eye Workshop. Ocular Surface, pp:75-92.

Fuhaid, N., Sahbana, M. A., & Arianto, A. 2011. Pengaruh medan elektromagnet

terhadap Konsumsi bahan bakar dan emisi gas buang pada motor

bensin. PROTON, 3(1).

Galperín, G., Berra, M., Marquez, M. I., Mandaradoni, M., Tau, J., & Berra, A. 2018.

Impact of environmental pollution on the ocular surface of Sjögren’s

syndrome patients. Arquivos brasileiros de oftalmologia, 81(6), pp. 481-489.

Gayton, J. L. 2009. Etiology, prevalence, and treatment of dry eye disease. Clinical

ophthalmology (Auckland, NZ), 3, p. 405.

62

George W., et al. 2014. "Blink patterns and lid-contact times in dry-eye and normal

subjects." Clinical ophthalmology (Auckland, NZ) 8. p. 869.

Guillon M., et al. 2010. Tear film evaporation – effect of age and gender. Cont Lens

Anterior Eye. 2010;33: pp. 171–5.

Gupta P. D, Muthukumar A. 2018. Minor to Chronic Eye Disorders Due to

Environmental Pollution: A Review. J Ocul Infect Inflamm 2, p. 108.

Herranz, R. M., & Herran, R. M. C. (Eds.). 2012. Ocular Surface: Anatomy and

Physiology, Disorders and Therapeutic Care. CRC Press.

Holland, E. J., Mannis, M. J., & Lee, W. B. 2013. Ocular Surface Disease: Cornea,

Conjunctiva and Tear Film E-Book: Expert Consult-Online and Print.

Elsevier Health Sciences, p. 17

Ismiyati. 2014. Pencemaran Udara Akibat Emisi Gas Buang Kendaraan Bermotor.

Jurnal Manajemen Transportasi & Logistik (JMTransLog), Vol. 01, No. 03,

pp. 243-246.

Kaštelan, Snježana et al. 2013. ‘Diagnostic Procedures And Management Of Dry

eye’. BioMed Research International. pp 1-6.

Khurana, A. K., & Khurana, B. 2015. Comprehensive Ophthalmology: With

Supplementary Book-Review of Ophthalmology. JP Medical Ltd. Pp. 386-390.

Lee, A. J. 2002. Prevalence and Risk Factors Associated with Dry Eye Symptoms: a

Population Based Study in Indonesia. The British Journal of

Ophthalmology, 86(12), pp. 1347-1351.

63

Lin, H., & Yiu, S. C. 2014. Dry eye disease: A review of diagnostic approaches and

treatments. Saudi journal of ophthalmology : official journal of the Saudi

Ophthalmological Society, 28(3), pp. 173-181.

Messmer, Elisabeth M. 2015. The Pathophysiology, Diagnosis, and Treatment of Dry

Eye Syndrome. Deutsches Ӓrzteblatt International. Dtsch Arztebl Int

2015; 112: pp. 71-82.

Muziansyah, D., Sulistyorini, R., & Sebayang, S. 2015. Model Emisi Gas Buangan

Kendaraan Bermotor Akibat Aktivitas Transportasi (Studi Kasus: Terminal

Pasar Bawah Ramayana Koita Bandar. Jurnal Rekayasa Sipil dan

Desain, 3(1), pp. 57-70.

Nurbiantara, S. 2010. Pengaruh Polusi Udara Terhadap Fungsi Paru Pada Polisi

Lalu Lintas di Surakarta. Surakarta. Skripsi: Fakultas Kedokteran UNS.

Notoatmodjo, S. 2010. Metodologi Penelitian Kesehatan. Jakarta : Rineka Cipta

Novaes, P. et al, 2007. Ambient levels of air pollution induce goblet-cell hyperplasia

in human conjunctival epithelium. Environmental health

perspectives, 115(12), 1753-1756.

Paudel, N. et al., 2017. Ocular surface symptoms among individuals exposed to

ambient levels of traffic derived air pollution–a cross-sectional

study. F1000Research, p. 6.

Perry, H. D. 2008. Dry eye disease: pathophysiology, classification, and

diagnosis. Am J Manag Care, 14(3 Suppl), pp. 79-87.

Pohan, N. 2002. Pencemaran udara dan hujan asam. Pencemaran Udara Dan Hujan

Asam.

64

Pohanish, R. P. 2017. Sittig's handbook of toxic and hazardous chemicals and

carcinogens. William Andrew. p. 1869.

Putro, I. A. E., & Abadi, I. 2012. Rancang Bangun Alat Uukur Emisi Gas Buang,

Studi Kasus: Pengukuran Gas Karbon Monoksida (CO). Digital Library ITS

Paper, Surabaya.

Ranjan, R. et al., 2016. Prevalence of Dry Eye and Its Association with Various Risk

Factors in Rural Setup of Western Uttar Pradesh in a Tertiary Care

Hospital. Open J Prev Med, 6(1), 57-63.

Rose, K. D. C dan Tualeka, A. R. 2014. Penilaian Risiko Paparan Asap Kendaraan

Bermotor Pada Polantas Polrestabes Surabaya Tahun 2014. The Indonesian

Journal of Occupational Safety and Health. Vol. 3, No. 1 Jan-Jun 2014, pp.

46-57

Schiffman, Rhett M. et al. 2000. Reliability and Validity of the Ocular Surface

Disease Index. Arch Ophtalmol/Vol. 118. American Medical Association.

Shah, S., & Jani, H. 2015. Prevalence and associated factors of dry eye: Our

experience in patients above 40 years of age at a Tertiary Care Center. Oman

journal of ophthalmology, 8(3), 151–156.

Stapleton, Fiona, et al. 2017."Tfos dews ii epidemiology report." The ocular

surface 15.3: 334-365.

Thomas, et al. 2012. The effect of smoking on the ocular surface and the precorneal

tear film. Australas Med J. 5(4):221–226.

65

Torricelli, A. A. M. et al. 2011. Ocular surface adverse effects of ambient levels of air

pollution. Arquivos brasileiros de oftalmologia, 74(5), 377-381.

Tugaswati, A. 2004. Emisi gas buang kendaraan bermotor dan dampaknya terhadap

kesehatan. Health and Human Ecology Journal, 61, pp. 261-275.

WHO (World Health Organization). 2005. Air Quality Guidelines – Global Update

2005. (https://www.who.int/)

Wijaya, V. N. 2018. Penyakit Mata Kering. Cermin Dunia Kedokteran, 45(3), pp.

192-196.

Xu, Li et al. “Smoking and the risk of dry eye: a Meta-analysis.” International

journal of ophthalmology vol. 9,10. Pp. 1480-1486.

Zhong, J. Y. et al, 2018. Association between Dry Eye Disease, Air Pollution and

Weather Changes in Taiwan. International journal of environmental research

and public health, 15(10), p. 2269.

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