http://doi.org/10.33698/NRF0072 Madhu Malini,Indarjit Walia, Sukhwinder Kaur
Abstract : Dry eye is disorder of the tear film due to tear deficiency or excessive evaporation which causes damage to the interpalpebral ocular surface and is associated with symptoms of ocular discomfort. Dry eye’s prevalence increases with age, hence it is extremely common in older people of both sexes. The present study was conducted with an objective to study lacrimation and associated symptoms of mild dry eye by application of warm compress among geriatric population (³60 years of age). Seventy four study subjects with mild dry eye participated in the study. By randomization they were divided into 36 experimental and 38 control subjects. All the subjects were interviewed and assessed for tear level and symptoms of mild dry eye on 1st and 7th day. Warm compress was administered among experimental group twice a day for seven days. Findings revealed that both the experimental and control subjects were homogenous in respect of age and gender. Tear level in both the eyes and symptoms of mild dry eye were compared among experimental and control subjects on 1st and 7th day. Among experimental subjects, symptoms as well as tear level were significantly improved on 7th day while there was no change in symptoms and tear level among control subjects on 7th day. It was concluded that warm compress is an effective, safe and economical method for the treatment of mild dry eye among geriatric population in the community.
Key words :Mild dry eye, tear level, warm compress.
Correspondence at :Indarjit Walia,
Principal National Institute of Nursing Education, PGIMER, Chandigarh, India
Introduction:Ocular problems due to a variety of eye diseases have been suggested as playing a role in decreased self assessed visual function and on other general activities of living independently.1, 2 Dry eye is one of the problems which lead to decreased visual function and interfere in general activities of daily living3. It is a disorder of tear film. The tear film which coats eyes is composed of three layers:
Oily layer (produced by meibomian gland); watery layer (produced by lacrimal gland); layer of mucus (produced by conjunctiva).4, Symptoms of dry eye vary considerably from one individual to another. Most patients complain of a foreign body sensation, burning and general ocular discomfor t. The discomfor t is typically described as a scratchy, dry, sore, gritty, smarting or burning feeling.5 Schirmer’s test is the simplest method to measure tear level. The tear level of10 mm or less than 10mm is considered as dry eye.6
Dry eye is common condition with prevalence of 11%- 17% in the general population and rates up to 29% in clinical optometry practices. The majority of patients with dry eye have a mild form of the condition: 65%-89% have mild dry eye, 12%-13% have moderate dry eye and 0%- 2% of the population have severe dry eye.7 In 1993- 1994 at the National Eye Institute/Industry Workshop, it was recognized that very little information was available on the prevalence of dry eye syndrome in the overall population. The first large-scale epidemiological study to report the prevalence of dry eye syndrome was the Salisbury study in USA.8
Dry eye’s prevalence increases with age, so that it is extremely common in older people of both sexes. The condition affects two to three times more than men. About six million women and three million men in U.S. have moderate or severe symptoms of the disease and scientist estimate that an additional 20- 30 million in this country have mild dry eye.9
In 1998 a study described the epidemiology of dry eye in adult population of Melbourne, Australia.10 The result had shown that there were 16.3 per cent cases of dry eye which were diagnosed by Schirmer’s test between age group 40-97 years. A study by A. Sahai and P. Malik, revealed that ninety two (18.4%) patients out of 500 patients had dry eye. Dry eye prevalence was maximum in those above 70 years of age (36.1%). It was significantly higher among females (22.8%) than males (14.9%), more common in rural residents (19.6%) than in urban (17.5%) and highest among farmers/ labourers (25.3%).11
The most effective treatment for mild dry eye is the application of heat to the glands through the closed eyelids. Olson et al found that warm compresses reduced the symptoms of dry eye.12 Mori et al reported that the application of a disposable eye- warming device to the eyelids for 5 minutes a day, in a group of Dry eye patients, decreased the symptoms of dry eye.13 Warm compress is a good therapy because it makes eyes feel better for a while. It is recommended that it should be applied two times a day (morning and evening).14,
Review of literature revealed that patients can benefit from applying warm compresses to their eyes. Majority of the older people in the community are from low socio economic status having symptoms of dry eye but they don’t go to medical practitioner for consultation due to ignorance. It is recommended that Dry eye should be treated at early stage (mild form) and literature has
revealed that warm compress is equally effective and economical and it is easy to administer in the community. It also helps in preventing complications of dry eye.
Objectives
Main objective was to study lacrimation and associated symptoms of mild dry eye by the applicaton of warm compress among geriatric population.
Materials and Methods
Study design of present study was quasi-experimental. It was carried out at village Dhanas, UT, Chandigarh in the month of January and February, 2007.Concepts which were taken for the study give the rationale for administering warm compress. Warm compress stimulates meibomian and lacrimal gland which helps in increasing tear level and reducing symptoms of mild dry eye. Procedure of warm compress, and tool was developed and validated from experts in the field of Nursing, Ophthalmology and Community Medicine. Schirmer’s test for measuring tear level was validated from consultant in Ophthalmology. Reliabilty of the tool was checked by Spearman’s rank correlation coefficient (rs) formula. Its value was found to be 0.927. As the value of rs lies between -1 and +1, therefore tool used for the study is reliable. Pilot study was conducted at Dhanas, U.T., Chandigarh for checking feasiblity and practability of the tool.
Survey was conducted prior to data collection to select study subjects from total geriatric population (179) of age group =60 years. Total geriatric population was assessed
for tear level in both eyes. No sampling technique was adopted for taking sample size. Only Seventy six mild cases of dry eye were identified, so all were taken as study subjects. By randomization (lottery method) they were divided into experimental and control subjects. Two experimental subjects were not available as they were out of station for 2-3 months during data collection. Therefore, sample size remained 74.Thir ty six in experimental group and thir ty eight in control group. Both experimental and control subjects were interviewed on 1st and 7th day.They were assessed for tear level in both the eyes and symptoms of mild dry eye. Warm compress was given among experimental subjects only for six days.
Results
Socio-demographic profile
Findings revealed that, about 52.8 per cent of the experimental group and 50 per cent of control group were from age group of 60 to 64 years. About 52.8 per cent of subjects from experimental group and 52.6 per cent of subjects from control group were males,
61.1 per cent of experimental group 52.6 per cent of control subjects were illiterate. Half of the subjects from experimental group (50%) belong to Hindu religion while 63.2 per cent subjects of control group belong to Sikh religion. As per marital status, 24(66.7%) subjects of experimental group and 21(55.3%) subjects of control group were married. Regarding their occupational status, 16(44.4%) subjects from experimental
Table- 1 : Distribution of subjects as per symptoms of mild dry eye on 1st day and 7th Professional N= 74
| Symptoms | 1st day | 7th | day | ||
| Experimental
subjects (n1=36) f(%) |
Control
subjects (n2=38 )f(%) |
Experimental
subjects f(%) |
Control
subjects f(%) |
||
| Soreness | |||||
| No | 07 (19.5) | 10 (26.3) | 32 (88.9) | 10 (26.3) | |
| Sometimes | 21 (58.3) | 22 (57.9) | 04 (11.1) | 21 (55.3) | |
| All the time | 08 (22.2) | 06 (15.8) | – | 07 (18.4) | |
| Scratchiness | |||||
| No | 02 ( 5.7) | 01( 02.6) | 32 (88.9) | 02 (05.2) | |
| Sometimes | 25 (69.3) | 27 (71.1) | 04 (11.1) | 25 (65.9) | |
| All the time | 09 (25.0) | 10 (26.3) | – | 11 (28.9) | |
| Dryness | |||||
| No | – | 03 (07.9) | 30 (83.4) | 03 (07.9) | |
| Sometimes | 27 (75.0) | 28 (73.7) | 06 (16.6) | 27 (71.0) | |
| All the time | 09 (25.0) | 07 (18.4) | – | 08 (21.1) | |
| Grittiness | |||||
| No | 04 (11.1) | 03 (07.9) | 31 (86.1) | 05 (13.2) | |
| Sometimes | 25 (69.4) | 28 (73.7) | 05 (13.9) | 27 (71.0) | |
| All the time | 07 (19.5) | 07 (18.4) | – | 06 (15.8) | |
| Burning sensation | |||||
| No | 16 (44.4) | 24 (63.2) | 32 (88.9) | 22 (57.9) | |
| Sometimes | 17 (47.3) | 12 (31.6) | 04 (11.1) | 13 (34.2) | |
| All the time | 03 (08.3) | 02 (05.2) | – | 03 (07.9) | |
| Redness | |||||
| No | 16 (44.4) | 26 (68.5) | 32 (88.9) | 24 (63.2) | |
| Sometimes | 16 (44.4) | 11 (28.9) | 04 (11.1) | 12 (31.6) | |
| All the time | 04 (11.2) | 01 (02.6) | – | 02 (05.2) | |
| Difficult to open eyes in bright light | |||||
| No | 16 (44.4) | 24 (63.2) | 26 (72.2) | 23 (60.4) | |
| Sometimes | 07 (19.5) | 07 (18.4) | 07 (19.5) | 08 (21.2) | |
| All the time | 13 (36.1) | 07 (18.4) | 03 (08.3) | 07 (18.4) | |
| Eye irritation when wake up | |||||
| No | 24 (66.7) | 27 (71.0) | 33 (91.7) | 27 (71.0) | |
| Sometimes | 03 (08.3.) | 05 (13.2) | 01 (02.8) | 05 (13.2) | |
| All the time | 09 (25.0) | 06 (15.8) | 02 (05.5) | 06 (15.8) | |
| Sleep with partially open eyes | |||||
| No | 32 (88.9) | 34 (89.5) | 35 (97.2) | 35 (92.2) | |
| Uncertain | 03 (08.3) | 03 (07.9) | 01 (02.8) | 02 (05.2) | |
| Sometimes | – | 01 (02.6) | – | – | |
| All the time | 01 (02.8) | – | – | 01 (02.6) | |
| Blink eyes very frequently | |||||
| No | 29 (80.6) | 35 (92.1) | 35 (97.2) | 34 (89.5) | |
| Uncertain | 03 (08.3) | – | – | – | |
| Sometimes | 03 (08.3) | 03 (07.9) | 01 (02.8) | 03 (07.9) | |
| All the time | 01 (02.8) | – | – | 01 (02.6) | |
group and 18(47.4%) subjects of control group were housewives and about 9(25%) subjects of experimental group and 13(34.2%) subjects of control group were staying at home. About one four th (27.8%) of experimental group and 39.5 per cent of control group had per capita monthly income ranging between Rs. 501/- to Rs. 1000/-.
Distribution of subjects as per symptoms of mild dry eye on 1st day and 7th day
On 1st day, complains of subjects from experimental group were having soreness (58.3%), scratchiness (69.3%), dryness
(75%), grittiness (69.4%), burning sensation
(47.3%) and redness sometimes (44.4%). While among control group 57.9 per cent of subjects had complains of soreness, scratchiness (71.1%), dryness (73.7%),
grittiness (73.7%), burning sensation (63.2%) and redness sometimes (68.5%). After 6 days of intervention (warm compress), 88.9 per cent subjects from experimental group got relief of these symptoms while there was no change in symptoms among subjects from control group on 7th day (Table 1).
Fig.1 depicts Tear level in right eye among study subjects on 1st & 7th day. On 1st day among experimental group, 33(91.6%) subjects had tear level between 8-10mm (mild) in the right eye, 2(5.6%) subjects had tear level between 5-7mm (moderate). and only one subject had normal tear level in their right eye. Among control group, 34(89.4%) subjects had tear level between 8-10mm (mild), 2(5.3%) subjects had tear level between 5-7mm (moderate) & 2(5.3%) subjects had normal tear level in their right eye. While on 7th day, tear level of 8-10mm (mild) remained in 50% subjects of experimental group, 17(47.2%) subjects of experimental group had normal tear level; only one subject had moderate tear level. Among control group, there was no change in tear level on 7th day, 34(89.4%) subjects had mild tear level(8-10mm),2(5.3%) subjects had moderate tear level (5-7mm), only 2(5.3%) subjects had normal tear level(>10mm).