I saw a patient today for the first time who is an internist has been treated for dry eye for years. She really looked to me more like chronic inflammatory OSD due to blepharitis and possible allergy with Rosace, plugging of the glands, loss of lashes, conjunctivochalsis etc. She had no plugs in but had a normal lacrimal lake interrupted by conjunctivochalasis and tear osmolarity was 289 OD 291 OS. No lissamine green stain.
What was interesting was that her Schirmer strips was only about 4mm before anesthetic but 13mm or so with anesthetic in both eyes. I know that this is not the most reliable test in the world but still…..I’m having a hard time explaining this to a physician who is a patient. She says she has had plugs in the past and benefited from them but they fall out and that she tried Restasis and it did not help.
Wondering if anybody can explain why that might be to me. Usually it’s the other way around with Schirmer’s . Perhaps I’m missing something here so I thought I’d throw it out to the group.
- highly variable results between testers and even with the same tester on repeated testing
- large variations in results depending on time of day or which day was tested
- poor correlation to other recognized measures of DES
- no generally accepted way to even perform the test
- no generally accepted values of normal or abnormal
- no generally accepted practice on what to do with test results in terms of therapy
- many top cornea/refractive specialists have therefore abandoned routine Schirmer’s testing
- therefore, it is NOT a “gold standard” and many top surgeons wouldn’t even call it a “bronze” standard
*Emil William Chynn, MD, FACS, MBA*
*Dartmouth / Columbia / Harvard / Emory / NYU-trained *
*1st eye surgeon in NYC to have LASIK himself (1999)*
*Switched to SafeSight for better safety & vision (2005)*
*Performed highest Rx (-22.00) ever lasered in USA (2010)*
*Only High-Volume Pure Non-Cutting Refractive Surgeon in USA*