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Norihiko Yokoi, Shigeru Kinoshita, Anthony J. Bron, John M. Tiffany, Jiro Sugita, Tsutomu Inatomi; Tear Meniscus Changes during Cotton Thread and Schirmer Testing. Invest. Ophthalmol. Vis. Sci. 2000;41(12):3748-3753.
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purpose. To elucidate the effect of the cotton thread test (CT-T) and Schirmer
test (S-T) on the tear reservoir by evaluating the radius of tear
methods. The radii (R) of the central lower tear menisci were
measured by a newly developed video meniscometer in 11 eyes of 11
normal volunteers (6 men, 5 women; mean age, 27.7 ± 3.6 years[
SD]) and 9 eyes of 9 patients with tear deficiency and severe dry
eye in whom the puncta had been therapeutically occluded (9 women; mean
age, 50.6 ± 10.4 years). In this dry eye group, the absence of
reflex tearing, coupled with the absence of lacrimal drainage due to
punctal occlusion allowed more precise observation of the removal of
tears from the meniscus. A 1-minute CT-T was performed, followed after
an interval of 10 minutes by a 1-minute S-T. Tear meniscus curvature
was documented before (R 0) and during
the tests at 30 seconds (R 30) and 60
seconds (R 60).
results. In the normal group, respective R values (CT-T; S-T;
mean ± SD mm) were R 0 (0.26 ± 0.11; 0.26 ± 0.07), R 30 (0.27 ± 0.16; 0.20 ± 0.13), and R 60 (0.29 ± 0.15; 0.23 ±
0.21); and in the dry eye group, respective R values (CT-T;
S-T) were R 0 (0.59 ± 0.23;
0.51 ± 0.19), R 30 (0.52 ±
0.25; 0.22 ± 0.09), and R 60 (0.51 ± 0.19; 0.21 ± 0.08). It was demonstrated in the dry
eye group that R was diminished more by the S-T than by the
CT-T in the time course of the measurement (P = 0.01).
In the dry eye group alteration of R occurred within the
first 30 seconds, and in this group significant correlation was found
between R 0 and the S-T result (r= 0.67; P = 0.05), and between R 60– R 0 and the S-T result (r =−
0.81; P = 0.01). Also, there was a significant
correlation between R 60– R 0 and the S-T result in the normal
group (r = 0.71; P = 0.02). There were no
significant correlations between R 0 or R 60– R 0 and the CT-T results in either
conclusions. These studies afford some insight into the dynamics of the Schirmer
test, suggesting that wetting is influenced by the negative hydrostatic
pressure within the tear meniscus. With the protocol used, no
conclusion could be drawn about the relation between meniscus radius
and wetting of the cotton thread.
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