Abstract
• Background: Recently, the diagnostic criteria of dry eye have been tentatively approved in Japan. The aim of this study was to evaluate the diagnostic usefulness and the cutoff value of Schirmer's 1 test on applying these Japanese diagnostic criteria to patients with Sjögren's syndrome. • Methods: One hundred eyes of 50 patients with Sjögren's syndrome underwent a series of diagnostic tests, including Schirmer's I test, cotton thread test, tear film break-up time (BUT), fluorescein staining, and rose bengal staining. They were classified into definite dry eye, probable dry eye, and normal eye according to the Japanese criteria. The diagnostic usefulness of Schirmer's I test was evaluated in comparison with that of the cotton thread test or BUT, based on the diagnostic outcome by combination of the individual tests plus vital staining tests. The cutoff value of Schirmer's I test was evaluated, based on the results of sensitivity and specificity rates at each cutoff value from 0 to 10 mm. • Results: The diagnostic usefulness of Schirmer's I test was inferior to that of BUT, but superior to that of cotton thread test. The sensitivity and specificity were 80% and 53%, respectively, at a cutoff value of 5 mm and 88% and 35%, respectively, at a cutoff value of 10 mm. • Conclusion: In investigation of dry eye, both Schirmer's I test and BUT should be performed to detect tear abnormalities. The cutoff value of 5 mm in Schirmer's I test seems to be justified provided that the purpose of the test is comparison of inter-institutional data, not screening.
Similar content being viewed by others
References
Balik J (1952) The lacrimal fluid in keratoconjunctivitis sicca: A quantitative and qualitative investigation. Am J Ophthalmol 35:773–782
Beetham WP (1935) Filamentary keratitis. Trans Am Ophthalmol Soc 33:413–435
Cho P, Yap M (1993) Schirmer test. I. A review. Optom Vis Sci 70:152–156
Clinch TE, Benedetto DA, Feldberg NT, Laibson PR (1983) Schirmer's test: a closer look. Arch Ophthalmol 101:1383–1386
de Rötth A (1941) On the hypofunction of the lacrimal gland. Am J Ophthalmol 24:20–25
Farris RL, Gilbard JP, Stuchell RN, Mandel ID (1983) Diagnostic test in keratoconjunctivitis sicca. CLAO J 9:23–28
Fox RI, Robinson C, Curd J, Michelson P, Bone R, Howell FV (1986) First International Symposium on Sjögren's Syndrome: suggested criteria for classification. Scand J Rheumatol Suppl 61:28–30
Goren MB, Goren SB (1988) Diagnostic test in patients with symptoms of keratoconjunctivitis sicca. Am J Ophthalmol 106:570–574
Halberg GP, Berens C (1961) Standardized Schirmer tear test kit. Am J Ophthalmol 51:840–842
Hamano H, Hori M, Hamano T, Mitsunaga S, Maeshima J, Kojima S, Kanabe H, Hamano T (1983) A new method for measuring tears. CLAO J 9:281–289
Henderson JW, Prough WA (1950) Influence of age and sex on flow of tears. Arch Ophthalmol 43:224–231
Holly FJ, Lemp MA (1977) Tear physiology and dry eye. Surv Ophthalmol 22:69–87
Homma M, Tojo T, Akizuki M, Yamagata H (1986) Criteria for Sjögren's syndrome in Japan. Scand J Rheumatol Suppl 61:26–27
Jones LT (1966) The lacrimal secretory system and its treatment. Am J Ophthalmol 62:47–60
Lucca JA, Nunez JN, Farris RL (1990) A comparison of diagnostic test for keratoconjunctivitis sicca: Lactoplate, Schirmer, and tear osmolarity. CLAO J 16:109–112
Mackie IA, Seal DV (1981) The questionable dry eye. Br J Ophthalmol 65:2–9
Manthorpe R, Oxholm P, Prause JU, Schiødt M (1986) The Copenhagen criteria for Sjögren's syndrome. Scand J Rheumatol Suppl 61:19–21
Manthorpe R, Andersen V, Jensen OA, Oxholm P, Prause JU, Schiødt M (1986) Editorial comments to the four sets of criteria for Sjögren's syndrome. Scand J Rheumatol Suppl 61:31–35
Markusse HM, Hogeweg M, Swaak AJG, van Haeringen NJ, de Jong PTVM (1992) Ophthalmological examinations of patients with primary Sjögren's syndrome selected from a rheumatological practice. Br J Rheumatol 31:473–476
Oduntan AO, Oni GA (1995) Variability of the Schirmer tear test values in a normal Arab population. Clin Exp Optom 78:190–193
Paschides CA, Kitsios G, Karakostas KX, Psillas C, Moutsopoulos HM (1989) Evaluation of tear break-up time, Schirmer's I test and rose bengal staining as confirmatory test for keratoconjunctivitis sicca. Clin Exp Rheumatol 7:155–157
Pinschmidt NW (1970) Evaluation of the Schirmer tear test. South Med J 63:1256, 1272
Schirmer O (1903) Studien zur Physiologie und Pathologie der Tränenabsonderung und Tränenabfuhr. Graefe's Arch Clin Exp Ophthalmol 56:197–291
Skopouli FN, Drosos AA, Papaioannou T, Moutsopoulos HM (1986) Preliminary diagnostic criteria for Sjögren's syndrome. Scand J Rheumatol Suppl 61:22–25
The Japanese Community Study Group on Diagnostic Criteria for Dry Eye (1995) Definition and criteria of dry eye. Ganka 37:765–770
van Bijsterveld OP (1969) Diagnostic tests in the sicca syndrome. Arch Ophthalmol 82:10–14
Vitali C, Moutsopoulos HM, Bombardieri, The European Community Study Group on Diagnostic Criteria for Sjögren's Syndrome (1994) Sensitivity and specificity of tests for ocular and oral involvement in Sjögren's syndrome. Ann Rheum Dis 53:637–647
Whitcher JP (1987) Clinical diagnosis of the dry eye. Int Ophthalmol Clin 27:7–24
Wright JC, Meger GE (1962) A review of the Schirmer test for tear production. Arch Ophthalmol 67:564–565
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Danjo, Y. Diagnostic usefulness and cutoff value of Schirmer's I test in the Japanese diagnostic criteria of dry eye. Graefe's Arch Clin Exp Ophthalmol 235, 761–766 (1997). https://doi.org/10.1007/BF02332860
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02332860