Rear 4-minute Schirmer Test, A Modified Indicator of Schirmer Test in Diagnosing Dry Eye

Abstract This study was desgined to find a reliable and convenient indicator (a modified Schirmer test) to improve the accuracy of assessing tear secretion and diagnosing dry eye. This is a prospective continuous study on 180 volunteers. Schirmer test I without anesthesia was performed once on both eyes to determine the value of normal Schirmer test. The values of tear secretion were recorded in each minute. Examined individuals also underwent other examinations: the standard patient evaluation of eye dryness (SPEED), the Ocular Surface Disease Index (OSDI), fluorescein stain, tear film breakup time (BUT), and Meibomian gland (MG)grading. The participants were divided into two groups: dry eye (DE) groupand non-dry eye (ND) group. The mean age was 39.41±14.05 years in DE group and 37.62±13.17 in ND group. The value of 2-minute Schirmer test, rear 3-minute Schirmer test, rear 4-minute Schirmer test and 5-minute Schirmer test was 5.36±4.63, 5.57±2.11, 7.21±4.13 and 10.93±6.30 respectively in DE group. And these indicators was 8.25±6.80, 2.73±2.31, 7.36±3.42, 11.84±6.16 in ND group. The rear 4-minute ST has significant correlation with OSDI and SPEED in DE group (r =-0.242/-0.183) and in ND gruop(r =-0.316 /-0.373). Meanwhile, rear 4-minute ST had stronger connection with fBUT(r =0.159) and MG (r =-0.162) in DE gruop. And rear 4-minute ST also had higher accuracy in diagnosing severe dry eye and borderline dry eye.The rear 4-minute Schirmer test may be a supplement indicator in assessing tear secretion and diagnosing dry eye.

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The study of dry eye and meibomian glands in psoriasis

European Journal of Ophthalmology ◽

10.1177/11206721211007096 ◽

2021 ◽

pp. 112067212110070

Author(s):

Ahmad Reza Taheri ◽

Elahe Allahyari ◽

Mostafa Zeinaly ◽

Malihe Nikandish

Keyword(s):

Dry Eye ◽

Structural Parameters ◽

Tear Film ◽

Meibomian Gland ◽

Medical Sciences ◽

Schirmer Test ◽

Ocular Surface Disease Index ◽

Meibomian Glands ◽

And Gender ◽

And Control

Background: To investigate aqueous and lipid layers of the tear film as well as meibomian gland structure by meibography in psoriatic patients in the Iranian population. Methods: This case-control study was conducted on 31 psoriasis patients and 31 controls in Birjand University of Medical Sciences in 2018. The sampling method was available from the date of approval of the proposal in the Ethics Committee until it reached the sample size. After entering the study, patients were examined individually with a slit lamp. Then, Ocular Surface Disease Index (OSDI) score assessment, Schirmer test 1, lacrimal measurement with SM tube, tear break-up time (TBUT), and meibomian glands imaging by SBM Sistemi were done. Finally, the obtained data were entered into SPSS 15 software and analyzed at a significant level of less than 0.05. Results: The two groups were matched according to age and gender ( p = 0.39 and p = 0.80; respectively). With the exception of the SM Tube score, the mean of all tear film and meibomian glands functional and structural parameters including Schirmer test 1, TBUT, and meibography were significantly different between patients and control groups. Moreover, the proportion of abnormal OSDI (OSDI ⩾ 13) and the dry eye was significantly higher in psoriasis patients. Conclusions: Psoriasis is associated with dry eye as well as meibomian glands atrophy and dysfunction.

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Evaluation of Dry Eye after Implantable Collamer Lens Surgery

Ophthalmic Research ◽

10.1159/000511197 ◽

2020 ◽

Author(s):

Haiting Chen ◽

Xueyan Feng ◽

Guangzeng Niu ◽

Yuxiang Fan

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Case Series ◽

Meibomian Gland ◽

Quality Score ◽

Control Group ◽

Ocular Surface Disease Index ◽

Implantable Collamer Lens ◽

Lens Surgery ◽

Breakup Time

Objectives: To evaluate dry eye (DE) and associated meibomian gland dysfunction parameters after Implantable Collamer Lens (ICL) surgery. Methods: This is a prospective observational case series. Patients who underwent ICL implantation without previous ocular diseases or ophthalmic treatments were enrolled. Their Ocular Surface Disease Index (OSDI), noninvasive breakup time (NIBUT), meibography, slit-lamp examination of the lid margin, corneal fluorescein staining (CFS), and Schirmer test I were examined preoperatively and at 1 and 3 months postoperatively. Results: A total of 117 eyes of 60 patients were enrolled, and 107 eyes completed 3-month follow-up period. OSDI, lid marginal abnormality, and meibomian gland (MG) secretion, and meibum quality score were significantly higher at 1 month postoperatively and recovered partially at 3 months after surgeries, while NIBUT was significantly decreased all the time. Patients with previous DE symptoms (OSDI score ≥12) showed not only lower Schirmer and TBUT values but also higher CFS, lid margin score, MG loss, MG secretion, and meibum quality scores compared with those in the control group after operations. Low Schirmer, NIBUT values, and high meibum quality score were determined as risk factors for DE symptoms after ICL surgery. Conclusions: ICL implantation has a bad influence on the ocular surface and MG functions. The influence may be more obvious in patients with existing DE.

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Efficacy of cyclic therapy with terpinen-4-ol in Demodex blepharitis

European Journal of Ophthalmology ◽

10.1177/1120672120919085 ◽

2020 ◽

pp. 112067212091908 ◽

Cited By ~ 2

Author(s):

Özlem Evren Kemer ◽

Emine Esra Karaca ◽

Dilay Özek

Keyword(s):

Ocular Surface ◽

Meibomian Gland ◽

Disease Index ◽

Ocular Surface Disease ◽

Schirmer Test ◽

Ocular Surface Disease Index ◽

Tea Tree ◽

Cyclic Treatment ◽

Pre Treatment ◽

Breakup Time

Purpose To describe the effectiveness of cyclic treatment with terpinen-4-ol, a tea tree oil component, on Demodex blepharitis. Methods The presence of Demodex was determined by eyelash rotation as proposed by Mastrota. Schirmer test, tear breakup time, ocular surface disease index, lid margin score, meibomian gland expressibility score, and Oxford grade were performed. Patients were advised to apply heat followed by terpinen-4-ol soaked wipes to eyelids twice a day for 2 weeks. At the end of 2 weeks, treatment was interrupted for 7–10 days. The same treatment was repeated once again. The patients were examined after the first and second cycle of treatment and after 1 year. Results There was a statistically significant improvement in Schirmer test (10.37 ± 4.73 and 13.13 ± 3.44 mm/5 min), tear breakup time (6.47 ± 3.31 and 7.6 ± 2.89 s), ocular surface disease index (47.94 ± 19.77 and 34.28 ± 13.40), lid margin score (3.2 ± 0.7 and 2.63 ± 0.71), meibomian gland expressibility scores (1.93 ± 0.64 and 1.4 ± 0.67), and Oxford grade (0.9 ± 0.8 and 0.5 ± 0.63) after the first cycle of treatment ( p < 0.05). The improvement in symptoms and tear function tests of the patients after the second cycle was significantly better than in pre-treatment levels. At 12-month follow-up, symptoms of two patients (93%) relapsed. Conclusion The administration of terpinen-4-ol to the eyelid margins in a cyclic manner in Demodex blepharitis is effective against adult and hatching Demodex and breaks the vicious cycle.

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Diagnostic Test Efficacy of Meibomian Gland Morphology and Function

Scientific Reports ◽

10.1038/s41598-019-54013-4 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Jiaxin Xiao ◽

Muhammed Yasin Adil ◽

Jonatan Olafsson ◽

Xiangjun Chen ◽

Øygunn A. Utheim ◽

...

Keyword(s):

Dry Eye ◽

Operating Characteristic ◽

Characteristic Curve ◽

Tear Film ◽

Cross Sectional Study ◽

Meibomian Gland ◽

Clinical Parameters ◽

Cross Sectional ◽

And Function ◽

Breakup Time

AbstractMeibomian gland dysfunction (MGD) is the leading cause of dry eye and proposed treatments are based on disease severity. Our purpose was to establish reliable morphologic measurements of meibomian glands for evaluating MGD severity. This retrospective, cross-sectional study included 100 MGD patients and 20 controls. The patients were classified into dry eye severity level (DESL) 1–4 based on symptoms and clinical parameters including tear-film breakup time, ocular staining and Schirmer I. The gland loss, length, thickness, density and distortion were analyzed. We compared the morphology between patients and controls; examined their correlations to meibum expressibility, quality, and DESL. Relative to controls, the gland thickness, density and distortion were elevated in patients (p < 0.001 for all tests). The area under the receiver operating characteristic curve was 0.98 (95% confidence interval [CI], 0.96–1.0) for gland loss, and 0.96 (CI 0.91–1.0) for gland distortion, with a cutoff value of six distorted glands yielding a sensitivity of 93% and specificity of 97% for MGD diagnosis. The gland distortion was negatively correlated to the meibum expressibility (r = −0.53; p < 0.001) and DESL (r = −0.22, p = 0.018). In conclusion, evaluation of meibomian gland loss and distortion are valuable complementary clinical parameters to assess MGD status.

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Pellevé™ vs Lipiflow™ MGD-Related Dry Eye Treatment Study: The ThermaLid™ Procedure

Journal of Dry Eye Disease ◽

10.22374/jded.v1i1.2 ◽

2018 ◽

Vol 1 (1) ◽

pp. e11-e21

Author(s):

Edward Hall Jaccoma ◽

Craig Litherland ◽

Andrew Jaccoma ◽

Aseef Ahmed

Keyword(s):

Dry Eye ◽

Randomized Study ◽

Meibomian Gland ◽

Treatment Modalities ◽

Ocular Surface Disease Index ◽

Non Invasive ◽

Standard Patient ◽

Significant Difference ◽

Surface Staining ◽

Time Point

Objective: To assess the safety and efficacy of the Pellevé Wrinkle Treatment System as compared to LipiFlow, for treatment of dry eye syndrome due to meibomian gland dysfunction (MGD). Materials and Methods: In this split face, randomized study, ten patients who met specific criteria for inclusion were followed after treatment with the Pellevé Wrinkle Reduction System (what the authors have dubbed the "thermaLid Procedure") and a standard LipiFlow procedure performed the same day, with 1 and 3 months follow-up. Pre- and post- treatment MGD was assessed using a variety of subjective and objective measurements. Results: The function of the meibomian glands improved significantly from baseline to 3 months for both thermaLid and Lipiflow treated eyes, with no significant difference between them, as measured by MGE grading, wax plug scoring, Standard Patient Evaluation of Eye Dryness (SPEED) and Ocular Surface Disease Index (OSDI) scoring. A significant change in conjunctival staining was found after both treatments at the 1-month time point but not the 3-month time point. thermaLid but not Lipiflow treatment, significantly decreased MARX line measurements at 3-months. Lipiview, Non-Invasive Tear Breakup Time (NITBUT), corneal surface staining, Tear Osmolarity, and anesthetic Schirmer's testing did not show statistically significant improvement, nor differences between treatment modalities. Conclusions: thermaLid treatment of the eyelids appears to show efficacy similar to Lipiflow treatment in reducing symptoms, reducing wax plugging and improving the number of functioning MGs as well as reducing conjunctival staining in MGD related dry eye disease.

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Crosslinked hyaluronic acid with liposomes and crocin for management symptoms of dry eye disease caused by moderate meibomian gland dysfunction

10.21203/rs.2.17536/v1 ◽

2019 ◽

Author(s):

José-María Sánchez-González ◽

Concepción De-Hita-Cantalejo ◽

María Carmen Sánchez-González

Keyword(s):

Hyaluronic Acid ◽

Dry Eye ◽

Meibomian Gland ◽

Dry Eye Disease ◽

Eye Disease ◽

Schirmer Test ◽

Ocular Surface Disease Index ◽

Artificial Tear ◽

Before And After ◽

Contralateral Eye

Abstract Background: To study the effect of uncrosslinked and crosslinked hyaluronic acid combined with other artificial tear components in patients with dry eye caused by moderate meibomian gland dysfunction.Method: Prospective, single-blind, contralateral eye study. Fifty eyes were analyzed (25 patients). Eye selection for each tear type was random, and the eye drop formulations Aquoral Forte® (artificial tear A) and Aquoral Lipo® (artificial tear B) were used. The determined dosing schedule was three times a day for six weeks, and the study participants underwent a clinical examination before and 45 days after lubricant treatment. The Schirmer test, tear breakup time (TBUT) test, and Ocular Surface Disease Index (OSDI) questionnaire were applied before and after instillation period with both types of artificial tears. Results: On the Schirmer test, a significant improvement was obtained with both tear A (p < 0.01) and tear B (p < 0.01). On the TBUT test, a significant improvement was obtained with tear A (p < 0.01) and tear B (p < 0.01). The OSDI score significantly decreased after instillation period with both artificial tear types (p < 0.01). Conclusion: Uncrosslinked hyaluronic acid combined with other components, such as tamarind seed polysaccharide, and crosslinked hyaluronic acid combined with liposomes and crocin are effective for management symptoms of dry eye disease.

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Noncontact Meibography in Patients with Keratoconus

Journal of Ophthalmology ◽

10.1155/2019/2965872 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Engy Mohamed Mostafa ◽

Marwa Mahmoud Abdellah ◽

Ashraf Mostafa Elhawary ◽

Amr Mounir

Keyword(s):

Morphological Changes ◽

Tear Film ◽

Cost Effective ◽

Lower Eyelid ◽

Meibomian Gland ◽

Control Group ◽

Schirmer Test ◽

Ocular Surface Disease Index ◽

Meibomian Glands ◽

Grade 3

Purpose. To examine the morphological changes in the meibomian glands of patients with keratoconus as well as to study the relationship between these changes in the morphology and several tear film parameters. Methods. Examination of the meibomian gland (MG) of 300 keratoconus patients presenting to the center using infrared noncontact meibography system (Sirius, CSO, Italy) between January 2017—January 2019. 100 eyes of healthy individuals were also enrolled as a control group. Tear breakup time (TBUT) test and Schirmer test II were evaluated. Subjective symptoms were also assessed using Ocular Surface Disease Index (OSDI). Results. Mean age of keratoconus patients was 19 ± 12 years and 21 ± 14 years in control group. Average TBUT was 4.9 ± 2.1 sec. and average Schirmer test was 5.3 ± 2.2 mm which was significantly lower than control group (p=0.05). Meibomian gland dropout in the lower eyelid of the keratoconus group was as follows: grade 0 (no loss of meibomian glands): 100 eyes; grade 1 (gland dropout area <1/3 of the total meibomian glands): 85 eyes; grade 2 (gland dropout area 1/3 to 2/3): 68 eyes; and grade 3 (gland dropout >2/3): 47 eyes. Conclusion. Keratoconus shows significant meibomian gland dropout and distortion that can be recorded by noncontact meibography. Sirius meibography is a simple, cost-effective method of evaluating meibomian gland dropout as a part of the routine refractive examination.

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Dry Eye in Systemic Sclerosis Patients: Novel Methods to Monitor Disease Activity

Diagnostics ◽

10.3390/diagnostics10060404 ◽

2020 ◽

Vol 10 (6) ◽

pp. 404

Author(s):

Caterina Gagliano ◽

Elisa Visalli ◽

Mario Damiano Toro ◽

Roberta Amato ◽

Giovanni Panta ◽

...

Keyword(s):

Systemic Sclerosis ◽

Dry Eye ◽

Tear Film ◽

Symptom Assessment ◽

Meibomian Gland ◽

Schirmer Test ◽

Skin Score ◽

Non Invasive ◽

Modified Rodnan Skin Score ◽

Severity Of The Disease

Background: In systemic sclerosis (SSc) patients, dry eye syndrome (DES) is the most frequent ocular feature. The aim of this study was to investigate ocular DES-related SSc patients and to establish any correlation with the severity of the disease. Methods: Retrospectively, data from 60 patients with SSc underwent ophthalmic examination, where non-invasive film tear break-up time (NIF-TBUT), tear film lipid layer thickness (LLT), anesthetic-free Schirmer test I, tear osmolarity measurement (TearLab System), and modified Rodnan skin score (mRSS) data were collected. The visual analog scale (VAS) and Symptom Assessment in Dry Eye (SANDE) methods were utilized. The results were correlated with mRSS and the duration of SSc. Results: Severe DES occurred in 84% of cases, and was more severe in women. The eyelids were involved in 86.6%, secondary to meibomian gland disease (MGD). A direct correlation was found between the tear osmolarity (mean 328.51 ± 23.8 SD) and skin score (mRSS) (r = 0.79; p < 0.01). Significantly reduced NIF-TBUT, LLT, and Schirmer test I values were observed in the case of severe skin involvement. Conclusions: SSc patients show lipid tear dysfunction related to the severity and duration of the disease due to inflammation and the subsequent atrophy of the meibomian glands.

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Tear Film Break-Up Time and Dry Eye Disease Severity in a Large Norwegian Cohort

Journal of Clinical Medicine ◽

10.3390/jcm10040884 ◽

2021 ◽

Vol 10 (4) ◽

pp. 884

Author(s):

Mazyar Yazdani ◽

Jørgen Fiskådal ◽

Xiangjun Chen ◽

Øygunn A. Utheim ◽

Sten Ræder ◽

...

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Characteristic Curve ◽

Tear Film ◽

Correlation Coefficients ◽

Meibomian Gland ◽

Discriminative Power ◽

Ocular Surface Disease Index ◽

Significant Difference ◽

Break Up

This study evaluated to what extent tear film break-up time (TFBUT) could discriminate pathological scores for other clinical tests and explore the associations between them. Dry eye patients (n = 2094) were examined for ocular surface disease index (OSDI), tear film osmolarity (Osm), TFBUT, blink interval, ocular protection index (OPI), ocular surface staining (OSS), Schirmer I test, meibomian expressibility, meibomian quality, and meibomian gland dysfunction. The results were grouped into eight levels of break-up time (≤2, ≥3, ≤5, ≥6, ≤10, ≥11, ≤15, and ≥16) with or without sex stratification. Receiver-operating characteristic curve (ROC) analysis and Pearson’s correlation coefficients were used to study TFBUT’s discriminative power and the associations among the tests, respectively. Above and below each TFBUT’s cut-off, all of the parameters indicated significant difference between groups, except OSDI (cut-off 15 s) and Osm (cut-offs 5 s–15 s). At TFBUT cut-off of 2 s, sex difference could be detected for OSDI, Osm, and OSS. OPI presented the strongest discriminative power and association with TFBUT in sharp contrast to Osm, holding the poorest discriminative power with no significant correlation. The remaining parameters were within the poor to very poor categories, both with regard to discrimination and correlation. In conclusion, patients with lower TFBUT presented with more severe DED parameters at all four defined cut-off values.

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Comparative of meibomian gland morphology in patients with evaporative dry eye disease versus non-dry eye disease

Scientific Reports ◽

10.1038/s41598-021-00122-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ricaurte Ramiro Crespo-Treviño ◽

Anna Karen Salinas-Sánchez ◽

Francisco Amparo ◽

Manuel Garza-Leon

Keyword(s):

Dry Eye ◽

Healthy Subjects ◽

Morphological Changes ◽

Tear Film ◽

Meibomian Gland ◽

Dry Eye Disease ◽

Eye Disease ◽

Ocular Surface Disease Index ◽

Evaporative Dry Eye ◽

The Impact

AbstractMany recent studies have showed that morphological changes are one of the key signs of meibomian gland disease (MGD). These changes can be seen even before symptom onset, potentially underestimating the prevalence of MGD; however, until now, there is no conclusive information about the impact of meibomian gland (MG) morphology in tear film physiology and disease. This study aimed to investigate the prevalence of anatomical and morphological MG alterations between patients with evaporative dry eye disease (DED) and healthy controls. Retrospective chart review of seventy-five patients with evaporative DED and healthy individuals who had dry eye assessments included Ocular Surface Disease Index questionnaire, meibum quality, meibum expressibility, lid margin abnormality, ocular staining, non-invasive tear film break-up time, and meibography. We did not find significant differences in MG alterations in the upper lid between healthy and DED subjects. Patients with evaporative DED presented MG alterations in the lower lid more frequently than healthy subjects (54.8 vs. 30.3%; p = 0.03). The presence of shortened glands was the only MG alteration that was more prevalent in the lower lid in dry-eye patients than in healthy subjects (p < 0.05). Subjects with evaporative DED presented more alterations in the lower lid than healthy subjects.

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