Assessment of Tear Film Parameters after Working Overnight in Intensive Care Nurses

Abstract

Objective: Intensive care unit is a special area with many life-saving technological tools and equipment. It is isolated with its general appearance and atmosphere. In these units, intensive care nurses with special skills work at a fast and intensive pace for special purposes. In this study, the effect of working shifts on tear tests of intensive care nurses was investigated. Material and Method: Thirty-two health workers without ocular or systemic disease who volunteered were included in the study. Complete ophthalmologic examination of sixty-four eyes was performed. The intensive care nurses were evaluated with Schirmer 1 test and Tear break up time test before the working shift at 16:00 and after the working shift at 08:30. Results: The group's biomicroscopic examination and fundus examination were evaluated as normal before the study.  The average intraocular pressure was 14.21 mmHg in the right eye and 13.75 mmHg in the left eye. Schirmer 1 test was done before working shift. The average was 26.28 mm in the right eye and 24.21 mm in the left eye. While the average Schirmer 1 testing after working shift was 19.53 mm in the right eye, the average was 17.71 mm in the left eye. Schirmer 1 test was found as statistically significant in both eyes before and after the working shift (p=0.00). Tear break up time test was found to be 16.78 seconds in average in right eye and 14.43 seconds in the left eye before the working shift. On the other hand, the test time was averagely 9.08 seconds in right eye and 8.71 seconds in the left eye after the working shift. Significant difference was found in tear break up time test when tear break up times before and after shifts were compared (p=0.00). Conclusion: Tear break up time test and Schirmer test values are decreasing after the working shift due to the lack of sleep of intensive care nurses.

Keywords

• Intensive care nurses,Schirmer test,Tear break up time

YOĞUN BAKIM HEMŞİRELERİNDE NÖBET SONRASI GÖZYAŞI BULGULARININ DEĞERLENDİRİLMESİ

Abstract

Amaç: Yoğun bakım servisleri 24 saat yoğun mesainin yapıldığı, personelin yeterli özen ve dikkatini gerektiren özel yalıtılmış alanlardır. Bu birimlerde mesai yapan personel büyük bir özveri ile yoğun bir tempoda çalışmaktadır. Bu çalışmada, yoğun bakım hemşirelerinde nöbet sonrası durumun gözyaşı testleri üzerine etkisi araştırıldı.

Gereç ve Yöntem: Oküler ve sistemik hastalığı olmayan 32 gönüllü sağlık personelinin 64 gözü çalışma kapsamına alındı. Çalışmaya katılan gönüllülerin tam oftalmolojik muayenesi yapıldı. Yoğun bakım hemşireleri nöbete başlamadan önce saat 16:00’da olmak üzere ve nöbet sonrası saat 08:30’da olmak üzere Schirmer 1 testi ve gözyaşı kırılma zamanı testi ile değerlendirildi.

Bulgular: Katılımcıların biyomikroskopik ve fundus muayenesi normal olarak değerlendirildi. Çalışmamızda ortalama göz içi basınc sağ gözde 14.21 mmHg, sol gözde 13.75 mmHg olarak bulundu. Nöbet öncesi bakılan Schirmer 1 testi; sağ gözde ortalama 26.28 mm, sol gözde ortalama 24.21 mm olarak bulunurken, nöbet sonrası Schirmer 1 testi sağ gözde ortalama 19.53 mm, sol gözde ortalama 17.71 mm olarak bulundu. Schirmer 1 testi her iki göz için nöbet öncesi ve nöbet sonrası karşılaştırıldığında istatistiksel olarak anlamlı fark bulundu (p=0.00). Gözyaşı kırılma zamanı testi ise nöbet öncesi sağ gözde ortalama 16.78 sn, sol gözde ortalama 14.43 sn, nöbet sonrası sağ gözde ortalama 9.08 sn, sol gözde ortalama 8.71 sn olarak tespit edildi. Gözyaşı kırılma zamanı testi her iki göz nöbet öncesi ve nöbet sonrası değerler karşılaştırıldığında istatistiksel olarak anlamlı fark bulundu (p=0.00).

Sonuç: Yoğun bakım hemşilerinde, nöbet sırasında uykusuz kalmanın gözyaşı kırılma zamanı ve Schirmer testi değerlerinde olumsuz değişiklikler yaptığı görülmüştür.

Keywords

• Yoğun bakım hemşireleri,Schirmer testi,Gözyaşı kırılma zamanı

References

1. 1. Terzi B, Kaya N. Nursing care of critically ill patients. Yoğun Bakım Dergisi. 2011;1:21-5.
2. 2. Çelik S, Taşdemir N, Kurt A, İlgezdi E, Kubalas Ö. Fatigue in intensive care nurses and related factors. Int J Occup Environ Med. 2017;8(4):1137-99.
3. 3. Books C, Coody L C, Kauffman R, Abraham S. Night Shift Work and Its Health Effects on Nurses. Health Care Manag. 2017;36(4):347-53.
4. 4. Uchino M, Schaumberg DA. Dry eye disease: Impact on quality of life and vision. Curr Ophthalmol. 2013;1(2):51-7.
5. 5. Lemp MA, Bron AJ, Baudouin C, Benítez Del Castillo JM, Geffen D, Tauber J et al. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol. 2011;151(5):792-8.
6. 6. Johnson ME, Murphy PJ. Changes in the tear film and ocular surface from dry eye syndrome. Prog Retin Eye Res. 2004;23(4):449-74.
7. 7. Ayaki M, Kawashima M, Negishi, K, Kishimoto T, Mimura M, Tsubota K. Sleep and mood disorders in women with dry eye disease. Scientific reports. 2016;6:35276. Doi:10.2147/OPTH.S148650.
8. 8. Kamperis K, Hagstroem S, Radvanska E, Rittig S, Djurhuus JC. Excess diuresis and natriuresis during acute sleep deprivationin healthy adults. Am J Physiol Renal Physiol. 2010; 299(2):404-11.

9. 9. Galor A, Felix ER, Feuer W, Shalabi N, Martin ER, Margolis TP et al. Dry eye symptoms align more closely tonon-ocular conditions than to tear film parameters. Br J Ophthalmol. 2015;99(8):1126-9.
10. 10. Fernandez CA, Galor A, Arheart KL, Musselman DL, Venincasa VD, Florez HJ et al. Dry eye syndrome, post traumatic stress disorder, and depression in an older male veteran population. Invest Ophthalmol Vis Sci. 2013;54(5):3666-72.
11. 11. Wen W, Wu Y, Chen Y, Gong L, Li M, Chen X et al. Dry eye disease in patients with depressive and anxiety disorders in Shanghai. Cornea. 2012;31(6):686-92.
12. 12. Lee W, Lim SS, Won JU, Roh J, Lee JH, Seok H et al. The association between sleep duration and dry eye syndrome among Korean adults. Sleep Med. 2015;16(11):1327-31.
13. 13. Zhang Y, Chen H, Wu X. Prevalence and risk factors associated with dry eye syndrome among senior high school students in acounty of Shandong Province, China. Ophthalmic Epidemiol. 2012;19(4):226-30.
14. 14. Kawashima M, Uchino M, Yokoi N, Uchino Y, Dogru M, Komuro A et al. The association of sleep quality with dry eye disease: the Osaka study. Clin Ophthalmol. 2016;10:1015-21.
15. 15. Nascimento DC, Andersen ML, Hip´olide DC, Nobrega JN, Tufik S. Pain hypersensitivity induced by paradoxical sleep deprivationis not due to altered binding to brain mu-opioid receptors. Behav Brain Research. 2007;178(2):216-20.
16. 16. Everson CA. Functional consequences of sustained sleep deprivation in the rat. Behav Brain Res. 1995;69(1-2):43-54.
17. 17. Leproult R, Copinschi G, Buxton O, Van Cauter E. Sleep loss results in an elevation of cortisol levels the next evening. Sleep. 1997;20(10):865-70.
18. 18. Dartt DA. Neural regulation of lacrimal gland secretoryprocesses: relevance in dry eye diseases. Prog Retin Eye Res. 2009;28(3):155-77.
19. 19. Sullivan DA. Tearful relationships? Sex, hormones andaqueous-deficient dry eye. Ocul Surf. 2004;2(2):92-123.
20. 20. Cirelli C. Cellular consequences of sleep deprivation in the brain. Sleep Med Rev. 2006;10(5):307-21.
21. 21. Ding C, Walcott B, Keyser KT. Sympathetic neural control of the mouse lacrimal gland. Invest Ophthalmol Vis Sci. 2003;44:1513-20.
22. 22. Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K et al. TFOS DEWS II diagnostic methodology report. Ocular Surf. 2017;15(3):539-74.
23. 23. Tiffany JM, Pandit JC, Bron AJ. Soluble mucins and the physical properties of tears. Invest Ophthalmol Vis Sci. 1998;438:229-34.
24. 24. Makateb A, Torabifard H. Dry eye signs and symptoms in night-time workers. J Curr Ophthalmol. 2017;29(4):270-3.
25. 25. Lee YB, Koh JW, Hyon JY, Wee WR, Kim JJ, Shin YJ. Sleep deprivation reduces tear secretion and impairs the tear film. Invest Ophthalmol Vis Sci. 2014;55(6):3525-31.
26. 26. Vitali C, Bombardieri S, Jonsson R. European Study Group on Classification Criteria for Sjögren's Syndrome. Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61(6):554-8.
27. 27. De Monchy I, Gendron G, Miceli C, Pogorzalek N, Mariette X, Labetoulle M. Combination of the Schirmer I and phenol red thread tests as a rescue strategy for diagnosis of ocular dryness associated with Sjögren's syndrome. Invest Ophthalmol Vis Sci. 2011;52(8): 5167-73.
28. 28. Gupta A, Heigle TJ, Pflugfelder SC. Nasolacrimal stimulation of aqueous tear production. Cornea. 1997;16(6):645-8.
29. 29. Chiang B, Asbell PA, Franklin B. Phenol-red thread tear test and Schirmer test for tear production in normal and dry eye patients. Invest Ophthalmol Vis Sci. 1988;29:337.
30. 30. Galor A, Feuer W, Lee DJ, Florez H, Faler AL, Zann KL et al. Depression, post-traumatic stress disorder, dry eye syndrome: a study utilizing the national United States Veterans Affairs administrative database. Am J Ophthalmol. 2012;154(2):340-6.
31. 31. Treuer K, Norman TR, Armstrong SM. Over night human plasma melatonin, cortisol, prolactin, TSH, under conditions of normal sleep, sleep deprivation, and sleep recovery. J Pineal Res. 1996;20(1):7-14.
32. 32. Zoukhri D. Effect of inflammation on lacrimal gland function. Exp Eye Res. 2006;82(5): 885-98.
33. 33. Ding C, Walcott B, Keyser KT. Sympathetic neural control of the mouse lacrimal gland. Invest Ophthalmol Vis Sci. 2003;44(4):1513-20.