Correlation of the Schirmer 1 and fluorescein clearance tests with the severity of corneal epithelial and eyelid disease.

OBJECTIVE To evaluate the correlations of the fluorescein clearance test (FCT) and the Schirmer 1 test with the severity of corneal epithelial and eyelid disease in normal patients and patients with tear film disorders due to meibomian gland disease (MGD) and/or aqueous tear deficiency (ATD). METHODS Nineteen normal control subjects, 16 patients with MGD associated with rosacea, 21 patients with noninflammatory atrophic MGD, and 43 patients with ATD were enrolled. There was a similar age and sex distribution in each group. Each patient completed a symptom severity questionnaire that consisted of 11 questions and then underwent a panel of diagnostic tests in the following order: assessment of corneal and conjunctiva sensation with the Cochet-Bonnet esthesiometer, FCT, assessment of corneal fluorescein staining, Schirmer 1 test (5 minutes without anesthesia), and biomicroscopic examination of the eyelid margins and meibomian glands. The FCT was performed with a fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus. By studying the best area under the receiver operating characteristic curves, we developed a formula that combined the FCT and Schirmer test results, which we termed the FCT corrected by Schirmer test. RESULTS The FCT showed stronger correlation with ocular irritation symptoms (r = 0. 35, P <.001), corneal fluorescein staining (r = 0.54, P<.001), and meibomian gland and eyelid pathologic signs than the Schirmer 1 test. A correction factor that was based on the best area under the receiver operating characteristic curves, added to the FCT score, improved its correlation with ocular irritation symptoms, eyelid margin and meibomian gland pathologic signs, and ocular surface sensitivity scores. CONCLUSIONS Corneal epithelial disease is correlated with decreased aqueous tear production and delayed tear clearance, whereas eyelid and MGD are correlated with delayed tear clearance. The FCT corrected by Schirmer 1 test improves the correlations of the FCT with ocular irritation symptoms, corneal epithelial and eyelid pathologic signs, and corneal and conjunctival sensitivity for patients with MGD and ATD.

[1]  W. Mathers,et al.  Tear flow and evaporation in patients with and without dry eye. , 1996, Ophthalmology.

[2]  L. Sobrin,et al.  Tear fluid gelatinase B activity correlates with IL-1alpha concentration and fluorescein clearance in ocular rosacea. , 1999, Investigative ophthalmology & visual science.

[3]  K. Tsubota,et al.  Decrease in Corneal Sensitivity and Change in Tear Function in Dry Eye , 1996, Cornea.

[4]  W. Feuer,et al.  Correlation of tear fluorescein clearance and Schirmer test scores with ocular irritation symptoms. , 1999, Ophthalmology.

[5]  M. Lemp.  Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. , 1995, The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc.

[6]  A. Tarkkanen,et al.  Ocular disease leads to decreased concentrations of epidermal growth factor in the tear fluid. , 1991, Current eye research.

[7]  K. Tsubota,et al.  Correlation of tear clearance rate and fluorophotometric assessment of tear turnover. , 1995, The British journal of ophthalmology.

[8]  J. Marshall,et al.  Effect of beam variables on corneal sensitivity after excimer laser photorefractive keratectomy , 1997, The British journal of ophthalmology.

[9]  K. Barton,et al.  Inflammatory cytokines in the tears of patients with ocular rosacea. , 1997, Ophthalmology.

[10]  T. Hamano,et al.  Ocular surface damage and tear lactoferrin in dry eye syndrome , 1994, Acta ophthalmologica.

[11]  I Buvat,et al.  Impact of scatter correction in planar scintimammography: a phantom study. , 1998, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[12]  R. Farris,et al.  Tear osmolarity--a new gold standard? , 1994, Advances in experimental medicine and biology.

[13]  R. Beuerman,et al.  The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. , 1998, Cornea.

[14]  K. Tsubota,et al.  Meibomian gland dysfunction in patients with Sjögren syndrome. , 1998, Ophthalmology.

[15]  M. Norn.  Meibomian orifices and Marx's line Studied by Triple Vital Staining , 1985, Acta ophthalmologica.

[16]  B. Munoz,et al.  Relation between signs and symptoms of dry eye in the elderly. A population-based perspective. , 1997, Ophthalmology.

[17]  R. Beuerman,et al.  A unified theory of the role of the ocular surface in dry eye. , 1998, Advances in experimental medicine and biology.

[18]  J. Baum,et al.  Basic tear flow. Does it exist? , 1980, Ophthalmology.

[19]  S. Pflugfelder,et al.  A standardized visual scale for evaluation of tear fluorescein clearance. , 2000, Ophthalmology.

[20]  S. Tseng,et al.  Frequent association of delayed tear clearance in ocular irritation , 1998, The British journal of ophthalmology.

[21]  S. Pflugfelder,et al.  Altered cytokine balance in the tear fluid and conjunctiva of patients with Sjögren's syndrome keratoconjunctivitis sicca. , 1999, Current eye research.

[22]  W. Feuer,et al.  Evaluation of Subjective Assessments and Objective Diagnostic Tests for Diagnosing Tear‐Film Disorders Known to Cause Ocular Irritation , 1998, Cornea.