Elsevier

The Ocular Surface

Volume 18, Issue 1, January 2020, Pages 141-147
The Ocular Surface

Original Research
Schirmer test results: are they associated with topical or systemic medication?

https://doi.org/10.1016/j.jtos.2019.11.003Get rights and content

Abstract

Purpose

To test whether Schirmer test (ST) results are associated with topical or systemic medication and to evaluate the distribution of tear fluid quantity in a 3-min and 5-min ST.

Methods

The Gutenberg Health Study is a population-based, prospective, observational cohort study in Germany. ST was assessed in a sub-cohort of 1,999 participants. ST was performed under topical anesthesia for 5 min (ST-5) or of 3 min (ST-3). Anthropometric factors, systemic diseases, use of systemic and eye medications were recorded. We used multivariable quantile regression analysis to assess the influence on ST measurements.

Results

The length of wetting of the Schirmer strips for ST-5 was 23.2 ± 9.31 mm for right and 22.9 ± 9.0 mm for left eyes. In ST-3, the measurements were 20.0 mm in right and 19.1 mm in left eyes. The clinical cut off of 10 mm for ST-5 corresponded with an 8 mm cut off for ST-3.

There was an association of smaller ST-5 measures with male sex, higher age, socioeconomic status and season (all p < 0.001), but not with diabetes or smoking. The use of prostaglandin or beta-blocker eye drops or oral non-steroidal anti-inflammatory drugs, drugs for peptic ulcer and gastro-oesophageal reflux disease, thyroid hormones, progesterone and estrogen combination drugs, and hypnotics and sedatives showed an association with smaller ST-5.

Conclusions

For the first time we describe the distribution of tear fluid quantity by ST in a very large cohort of the general population. Furthermore, we found associations of ST measures with topical and systemic medication.

Section snippets

Background

The tear film has an important role for the maintenance of ocular surface health [1]. In dry eye disease the lack of tear fluid is one of the reasons leading to the loss of homeostasis [1].

Dry eye disease is defined by the Tear Film and Ocular Surface Society Dry Eye Workshop II as “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface

Study population

The Gutenberg Health Study (GHS) is a prospective, population-based, single-center cohort study at the medical center of the Johannes Gutenberg University Mainz in Germany [16]. The research followed the tenets of the Declaration of Helsinki; informed consent was obtained from the participants after explanation of the nature and possible consequences of the study; and the research was approved by the institutional human experimentation committee. The study protocol and study documents were

Results

Our sample consisted of 1999 GHS participants: 603 participants had a 3 min sampling time and 1396 participants had a 5 min sampling time. On average, our sample was 59 years old and 46% of the study participants were female (Table 1), 11.5% had diabetes mellitus and 14.9% smoked.

Median tear fluid quantity for ST-5 was 28.0 mm for right eyes and 27.0 mm for left eyes (Fig. 1). For ST-3, median tear fluid quantity was 13.0 mm in right eyes and 13.0 mm in left eyes (Fig. 2).

8.7% of the right eyes

Discussion

The diagnosis of dry eye disease is still complicated especially in cases with severe symptoms, but hardly any signs of ocular surface damage. It is crucial to evaluate diagnostic tests even though they are established in the diagnosis of dry eye disease. Surprisingly, distribution of tear fluid quantity measured by a Schirmer test with in the general population is unknown. To the best of our knowledge, this is the first paper that reports the distribution and associated factors of tear fluid

Conclusion

In summary, for the first time, we provide large normative data for tear fluid quantity measured by a 3 and 5 min Schirmer test with topical anesthesia. Participants with topical prostaglandins or beta-blockers showed lower Schirmer test results when analyzing the median. Furthermore, systemic non-steroidal anti-inflammatory drugs, thyroid hormones, progesterone and estrogen combination drugs, drugs for peptic ulcer and gastro-oesophageal reflux disease as well as hypnotics incl. sedatives

Consent for publication

Not applicable.

Availability of data and material

The analysis presents clinical data of a large-scale population-based cohort with ongoing follow-up examinations. This project constitutes a major scientific effort with high methodological standards and detailed guidelines for analysis and publication to ensure scientific analyses on highest level. Therefore, data are not made available for the scientific community outside the established and controlled workflows and algorithms.

To meet the general idea of verification and reproducibility of

Funding

The Gutenberg Health Study is funded through the government of Rhineland-Palatinate (“Stiftung Rheinland-Pfalz für Innovation”, contract AZ 961-386261/733), the research programs “Wissen schafft Zukunft” and “Center for Translational Vascular Biology (CTVB)” of the Johannes Gutenberg-University of Mainz, and its contracts with Boehringer Ingelheim and PHILIPS Medical Systems, including unrestricted grants for the Gutenberg Health Study. Philipp S. Wild is funded by the Federal Ministry of

Authors' contributions

Conceived and designed the study: UH, AKS, SN, KJL, TM, PSW, MB, IS, NP; analyzed and interpreted the data: AS, UH, AKS, NP; wrote the paper: AKS, UH, SN, NP; all authors revised the manuscript critically and approved the final version.

Declaration of competing interest

The authors declare that they have no competing interests.

Acknowledgements

We thank all study participants for their willingness to provide data for this research project, and we are indebted to all coworkers for their enthusiastic commitment.

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