2 Minute Schirmer’s Test is Acceptable

Surgeons and physicians everywhere are tying to do their best with doing a good job with each patient to diagnose any underlying conditions. 

For years the Schirmer’s test was NOT used to determine aqueous year deficiency due to it’s unreliability and 5min duration. When I was it Harvard, I rarely saw it being used on any service. 
Still it provides some sort of objective measure even it is variable. And it is true that my patients with advanced autoimmune disease do have a clearly abnormal Schirmers. 
I have used now this test for years as it is one of the few ways we can measure an abnormal homeostasis of the year film. 
This study below indicates 2minutes of measurement is acceptable. 
We will begin to use this more to see what we find in patients but I expect it will help us in a certain category of inflammatory eye pain. 
Sandra Lora Cremers, MD, FACS 

Comparison between normal values of 2- and 5-minute Schirmer test without anesthesia.

Karampatakis V, et al. Cornea. 2010.


PURPOSE: To compare the 2- and 5-minute Schirmer test I (test without anesthesia) in healthy individuals so as to exploit the possibility of using the 2-minute instead of the 5-minute test.

MATERIAL AND METHOD: 162 healthy (81 males and 81 females) individuals (without dry eye symptoms and free of pathology affecting tear secretion and tear drainage), aged between 20 and 85 years, were recruited in the study (3 age-groups: 20-45, 46-65, and 66-85 years). Schirmer test I (test without topical anesthesia) was performed in both eyes simultaneously. The values of tear secretion were recorded in 2 and 5 minutes and compared in relation to age and gender. The patients were asked to comment on the duration and the discomfort they felt.

RESULTS: In 2 minutes, the average tear secretion was 12.71 +/- 2.47 mm (mean +/- SD) for the right eyes and 12.62 +/- 2.09 mm for the left eyes and in 5 minutes, 16.74 +/- 3.59 and 16.831 +/- 3.38 mm, respectively. For confidence interval of 99%, the mean values of tear secretion, in individuals who were expected to have normal secretion, were higher than 10 mm in 2 minutes and higher than 13 mm in 5 minutes (significance level 1% or a = 0.01). Only 5.55% of the eyes presented values <10 mm (7-9.5 mm) in the 2-minute test and values <13 mm (8.5-12.5 mm) in the 5-minute test. There was no significant difference in tear secretion between males and females, between the different age-groups, and between right and left eyes. All the examined individuals expressed their negative comments and considered the test as an unpleasant procedure and consequently preferred the shorter possible duration.

CONCLUSION: The 2-minute test is more acceptable by both the examiners and the examined individuals and may be used, in respect to the above results, as an alternative of the 5-minute test. Normal individuals tend to have Schirmer test I values > or = 10 mm in 2 minutes, irrespective of age and gender.

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