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Tear Meniscus Changes during Cotton Thread and Schirmer Testing

¹ From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Japan; and the ² Nuffield Laboratory of Ophthalmology, University of Oxford, United Kingdom.

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 meniscus curvature.

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 (R₀) and during the tests at 30 seconds (R₃₀) and 60 seconds (R₆₀).

RESULTS. In the normal group, respective R values (CT-T; S-T; mean ± SD mm) were R₀ (0.26 ± 0.11; 0.26 ± 0.07), R₃₀ (0.27 ± 0.16; 0.20 ± 0.13), and R₆₀ (0.29 ± 0.15; 0.23 ± 0.21); and in the dry eye group, respective R values (CT-T; S-T) were R₀ (0.59 ± 0.23; 0.51 ± 0.19), R₃₀ (0.52 ± 0.25; 0.22 ± 0.09), and R₆₀ (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 R₀ and the S-T result (r = 0.67; P = 0.05), and between R₆₀– R₀ and the S-T result (r = -0.81; P = 0.01). Also, there was a significant correlation between R₆₀– R₀ and the S-T result in the normal group (r = 0.71; P = 0.02). There were no significant correlations between R₀ or R₆₀– R₀ and the CT-T results in either group.

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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