DIAGNOSTIC TESTS

FOR
TEAR DYSFUNCTION
Tear Breakup Time (TBUT)
■ This can be observed after fluorescein has been placed in the conjunctival
cul-de-sac.
■ The ophthalmologist then examines the tear film using a broad beam of the
slit lamp.
■ The patient is asked to open his or her eyes and refrain from blinking (after 1
or 2 blinks).
■ Counting the seconds until a dry spot appears.
■ The appearance of dry spots in less than 10 seconds is considered abnormal.
■ A more rapid tear film breakup time may indicate poor function of the mucin
or meibomian layer despite a sufficient amount of tears.
■ The mucin layer of the tear film helps spread the other layers evenly over the
corneal surface. It helps prevent tear evaporation.
Rose Bengal and Lissamine Green

■ Both available as a 1% solution or in impregnated strips, are other water-

soluble dyes.
■ They stain the epithelial cells of the cornea and conjunctiva when a
disruption occurs in the protective mucin coating.
■ These dyes are routinely used for evaluating tear deficiency states and for
detecting and assessing various epithelial lesions, such as the extent of
corneal intraepithelial neoplasia.
■ Rose bengal is toxic to the epithelium.
■ Lissamine green is better tolerated and has fewer toxic effects on cultured
human corneal epithelial cells.
 Basic Secretion Test
■ The basic secretion test is performed after instillation of a topical anesthetic
and light blotting of residual fluid from the inferior fornix.
■ To minimize irritation to the cornea during the test, a thin filter-paper strip
(5mm wide, 30 mm long) is placed at the junction of the middle and lateral
thirds of the lower eyelid, with 5 mm of the paper folded within the inferior
cul-de-sac and the remaining 25 mm of paper projecting over the lower
eyelid.
■ The test can be performed with the patient’s eyes open or closed, although
some recommend the eyes be closed to eliminate blinking.
■ Although normal tear secretion is quite variable, repeated measurements of
less than 3 mm of wetting after 5 minutes, with anesthetic, are highly
suggestive of aqueous tear deficiency (ATD), whereas 3–10 mm is equivocal.
Schirmer I Test

■ The Schirmer I test, which is similar to the basic secretion test

but is done without topical anesthetic, measures basic and
reflex tearing combined.
■ Less than 5.5 mm of wetting after 5 minutes is diagnostic of
ATD.
■ Although this test is relatively specific, its level of sensitivity is
poor. Using lower cut off measurements increases the specificity
of these tests but decreases their sensitivity.
Schirmer II Test

■ The Schirmer II test, which measures reflex secretion, is performed in

a similar manner but with topical anesthetic.
■ After the filter-paper strips have been inserted into the inferior
fornices, a cotton-tipped applicator is used to irritate the nasal
mucosa.
■ Wetting of less than 15 mm after 2 minutes is consistent with a defect
in reflex secretion.
■ Although an isolated abnormal result for any of these tests can be
misleading, serially consistent results are highly suggestive.
■ Schirmer testing is also useful in demonstrating to patients the
presence of an ATD.
■ AAO : 2016. External Disease and Ocular Section 8
 TERIMA KASIH
MOHON SARAN DAN BIMBINGANNYA