EYE CONDITIONS

ASSOCIATED WITH
EXPOSURE TO HAZE
Author : dr. Rosmaryati Manalu, Sp.M
Co- author : dr. Andy Narang; dr. Tria Pertiwi
Within 18 years forest and land fires occur annually in Sumatra and Kalimantan.
Forest and land fires in Indonesia by 2015 are the worst in history. Between January
and November 2015, over 100.000 forest fires devoured millions of hectares of forest
in Indonesia.

Picture 1. The atmosphere around the Kahayan River with the haze
Source: Nasional Tempo, Posted on October 22th 2015

One of the causes of forest fires is the habit of communities and companies
clearing plantation land by burning. The Indonesian government owns the majority of
the forest, and to use it is granted to the large companies and smallholders. The forest
is burned to make the land used to be clean, easy to work, free of pests and diseases
and get the ashes of combustion, which are rich in minerals. The tradition repeatedly
happens every year.

Picture 2. Forest and land fires in Central Kalimantan

Source: www.wwf.or.id Posted on October, 6th 2009
The highest number of fires was observed in 6 provinces in Indonesia, namely Riau,
Jambi, South Sumatra, West Kalimantan, Central Kalimantan and South Kalimantan.

Picture 3. The increasing of the Fire Point in 5 Provinces of the Ministry of Health
Monitoring Period from January to November 2015.

The increase of fire point is seen starting from June 2015. From Picture 3,
Central Kalimantan province has the most fire point that is 12.327 points.
Based on the decision of the Minister of Health No. 289 in 2013 on the Control
Procedure of Air Pollution Effects of Forest Fire on Health, air quality monitoring
uses the Air Quality Index (ISPU). ISPU is obtained from Health Department or
Local Environmental Management Agency or Regional Health Laboratory. The
parameters are dust, Sulfur dioxide, Carbon monoxide, Ozone and Nitrogen dioxide.

ISPU Air Polution Level

0-50 Good
51-100 Moderate
101-199 Unhealthy
200-299 Very Unhealthy
300-399 Dangerous
>400 Hazardous

The phase of a forest fire disaster is a phase in which forest fires start and is marked
by the number of the Air Quality Index (ISPU) > 200. During the September -
October period, the highest monthly ISPU rates in 6 provinces monitored by the
Ministry of Health are at extremely hazardous levels (> 400). The highest ISPU score
found in Central Kalimantan Province is above the hazardous status low limit even
above the highest value of the other 5 provinces.
Picture 4. The highest ISPU in 6 provinces affected by haze from September to
October 2015

The smoke of forest fire contains mixtures of gases, particles and chemicals due to
incomplete combustion. The smoke composition of forest fires consists of gases such
as carbon monoxide, nitrogen dioxide, ozone, sulfur dioxide and others. Particles
arising from forest fires are called Particulate matter. Sizes greater than 10
micrometers usually do not enter the lungs but can enter the mucous of the eyes, nose
and throat. In the quick run means the smoke of forest fire will cause irritation of the
eyes, nose throat so it can cause symptoms of fairy eyes, watery and discomfort.
Adverse health impacts can also occur in people especially in vulnerable groups such
as infants, toddlers, pregnant women, elderly and people with health problems in the
lungs and heart.

Eye Condition Associated with Exposure to Haze

Short Term Exposure

1. Conjunctivitis

Allergic conjunctivitis is the most common disease seen with environmental

variations. Acute allergic conjunctivitis associated with type 1 immediate
hypersensitivity reaction-mediated by immunoglobulin E (IgE) and mast cell
activation stimulated by direct exposure of ocular mucosal surfaces to
environmental allergens like particulate matter. Reaction may be limited to
eyes or may be part of generalized allergic reaction with nasal and respiratory
symptoms. It is usually bilateral and its clinical features include itching,
burning and mild to moderate infection, which may progress to variable
degree of glassy chemosis with papillary reaction more in the upper tarsal
conjunctiva. A watery or mucoid stringy discharge may be present.
 2. Dry Eyes

The level of humidity affects the eyes. In dry weather, eye symptoms will
worsen. Dry eye syndrome is due to decrease in quality or quantity of tears. It
may result in decreased sensitivity of cornea. It may be due to excessive
evaporation or decreased formation of tears. The air causes eye irritation.
Symptoms of dry eyes include eye fatigue and discomfort, redness, itching,
dryness, irritation.

3. Eye Foreign Body

Eye foreign body is foreign material on or in cornea, conjunctiva. It

generally falls under the category of minor ocular trauma. Small particles may
become lodged in the corneal epithelium or stroma. The foreign object may set
off an inflammatory cascade resulting in dilatation of the surrounding vessels
and subsequent edema of the lids, conjunctiva and cornea.
If not removed, eye foreign body can cause infection or tissue necrosis impact
of blindness.
Foreign body is one of the most frequent causes of visits for ocular
emergencies. Sometimes, the foreign body may not be present at the time of
examination, having left the residual abrasion with resultant pain.

Long Term Exposure

1. Cataract

Cataract is cloud area in the lens inside the eye, which is normally clear.
Cataracts can develop in one or both eyes. A normally clear lens allows light
to pass through to the back of the eye, so that patient can see well-defined
 images. If a part of the lens becomes opaque, light doesn’t pass through easily
and the patient’s vision becomes blurry.
Cataract can precipitate by the excessive heat produced by combustion
activities, which could result in coagulation of the protein materials in the
crystalline lens. Lifetime lead exposure may increase the risk of developing
cataract even in unborn babies, resulting congenital cataract.

2. Pterygium

Pterigium is a growth that develops on the conjunctiva or mucosa

membrane that covers the white part of the eye. It is a benign or noncancerous
growth that is often shaped like a wedge. In some case, a pterygium can
extend to the cornea.
Pterygium are caused by too much exposure to UV light, dry air, and
excessive heat. They occur more often in people who live in warm climate,
especially those who living in areas where combustion activities.
Pterygium usually not cause blind, but can interfere with vision if
further growth is not checked as it encroaches on the corneal surface. In some
patient pterygium can be inconveniencing with occasional complaints of
itching and sandy sensation.

The haze caused by forest fires in Indonesia is a routine disaster every year
that raises health problems. Health problems are the result of a wider problem
involving sectors of culture, education, economics, the environment and some other
sectors. Therefore, to overcome the haze problem, especially forest and land fires by
improving and educating in several related sectors.
References:

1. Ihekaire DE, 2015. Relationship between petrochemical pollution and ocullo-

visual in onelga region of the niger delta. 3(4):100-128.Ophthalmology
Research: An International Journal. 2015.
2. Nasional Tempo, Posted on October 22th 2015,
3. Pusat Data dan Informasi Kementerian Kesehatan RI. 2015
4. Subhrica, 2013. Effect of environment on eyes: a review. 24 (4). 381-84. Dept.
of ophthalmology
5. www.wwf.or.id Posted on October, 6th 2009