Correlation of tear fluorescein clearance and Schirmer test scores with ocular irritation symptoms

Adolfo A. Afonso, Dagoberto Monroy, Michael E. Stern, William J Feuer, Scheffer C G Tseng, Stephen C. Pflugfelder

Research output: Contribution to journalArticle

159 Citations (Scopus)

Abstract

Objective: To correlate and compare the Schirmer 1 test and a new method of measuring tear fluorescein clearance with the CytoFluor II fluorometer with the severity of ocular irritation symptoms, clinical signs of meibomian gland disease, corneal fluorescein staining scores, and corneal and conjunctival sensitivity. Design: Case-control study. Participants: Forty patients presenting with a chief complaint of ocular irritation, and 40 asymptomatic control subjects of similar age distribution. Intervention: All subjects completed a symptom questionnaire, a baseline ocular examination, fluorescein clearance test (FCT), and Schirmer 1 test. Main Outcome Measures: The FCT was performed with a CytoFluor II fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus 15 minutes after instillation of 5 μl of 2% sodium fluorescein. Severity of ocular irritation was assessed with a symptom questionnaire. Schirmer 1 test, biomicroscopic meibomian gland evaluation, corneal fluorescein staining score, and corneal and conjunctival sensation scores were assessed with the Cachet-Bonnet anesthesiometer in all subjects. Results: Irritation symptoms correlated with higher log tear fluorescein concentration (symptomatic 3.08 ± 0.62 units/μl, normal control 1.89 ± 0.7 units/μl, P <0.005) and lower Schirmer 1 test scores (symptomatic 12.6 mm, normal control 22.3 mm, P <0.005). The FCT showed greater predictive value for identifying ocular irritation than the Schirmer 1 test. A fluorescein concentration of 274 units/μl eliminated 80% of the normal subjects (specificity) and identified 85% of the abnormal subjects (sensitivity). Log of tear fluorescein concentration and the Schirmer 1 test correlated with meibomian gland orifice metaplasia (2.81 ± 0.78 units/μl and 14.47 ± 9.53 mm in those with metaplasia vs. 1.83 ± 0.71 units/μl and 23.14 ± 7.67 mm in those without metaplasia, P <0.001) and with the percentage of acinar dropout. Both log of tear fluorescein concentration and the Schirmer 1 test correlated with corneal fluorescein staining (Pearson correlation of 0.394 P <0.0001 for Schirmer 1 test and 0.312 P <0.005 for log of tear fluorescein). In addition, log of fear fluorescein and Schirmer 1 test scores correlated with corneal and conjunctival sensation scores (Spearman's rho for corneal sensation: log of tear fluorescein -0.38, P <0.003, Schirmer 1 test -0.39, P <0.002, and for conjunctival sensation: log of tear fluorescein - 0.391, P <0.001, Schirmer 1 test -0.23, P <0.061). Conclusions: The FCT shows a greater predictive value for ocular irritation than the Schirmer 1 test. It correlates better with age, meibomian gland dysfunction, and decreased corneal and conjunctival sensation. Decreased tear clearance was identified as a risk factor for ocular irritation, even in subjects with normal Schirmer scores. This simple technique may provide new clues into the mechanism and therapy of ocular irritation.

Original languageEnglish (US)
Pages (from-to)803-810
Number of pages8
JournalOphthalmology
Volume106
Issue number4
StatePublished - Apr 1 1999

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Fluorescein
Tears
Meibomian Glands
Metaplasia
Staining and Labeling
Corneal Diseases
Age Distribution
Signs and Symptoms

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Afonso, A. A., Monroy, D., Stern, M. E., Feuer, W. J., Tseng, S. C. G., & Pflugfelder, S. C. (1999). Correlation of tear fluorescein clearance and Schirmer test scores with ocular irritation symptoms. Ophthalmology, 106(4), 803-810.

Correlation of tear fluorescein clearance and Schirmer test scores with ocular irritation symptoms. / Afonso, Adolfo A.; Monroy, Dagoberto; Stern, Michael E.; Feuer, William J; Tseng, Scheffer C G; Pflugfelder, Stephen C.

In: Ophthalmology, Vol. 106, No. 4, 01.04.1999, p. 803-810.

Research output: Contribution to journalArticle

Afonso, AA, Monroy, D, Stern, ME, Feuer, WJ, Tseng, SCG & Pflugfelder, SC 1999, 'Correlation of tear fluorescein clearance and Schirmer test scores with ocular irritation symptoms', Ophthalmology, vol. 106, no. 4, pp. 803-810.
Afonso AA, Monroy D, Stern ME, Feuer WJ, Tseng SCG, Pflugfelder SC. Correlation of tear fluorescein clearance and Schirmer test scores with ocular irritation symptoms. Ophthalmology. 1999 Apr 1;106(4):803-810.
Afonso, Adolfo A. ; Monroy, Dagoberto ; Stern, Michael E. ; Feuer, William J ; Tseng, Scheffer C G ; Pflugfelder, Stephen C. / Correlation of tear fluorescein clearance and Schirmer test scores with ocular irritation symptoms. In: Ophthalmology. 1999 ; Vol. 106, No. 4. pp. 803-810.
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abstract = "Objective: To correlate and compare the Schirmer 1 test and a new method of measuring tear fluorescein clearance with the CytoFluor II fluorometer with the severity of ocular irritation symptoms, clinical signs of meibomian gland disease, corneal fluorescein staining scores, and corneal and conjunctival sensitivity. Design: Case-control study. Participants: Forty patients presenting with a chief complaint of ocular irritation, and 40 asymptomatic control subjects of similar age distribution. Intervention: All subjects completed a symptom questionnaire, a baseline ocular examination, fluorescein clearance test (FCT), and Schirmer 1 test. Main Outcome Measures: The FCT was performed with a CytoFluor II fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus 15 minutes after instillation of 5 μl of 2{\%} sodium fluorescein. Severity of ocular irritation was assessed with a symptom questionnaire. Schirmer 1 test, biomicroscopic meibomian gland evaluation, corneal fluorescein staining score, and corneal and conjunctival sensation scores were assessed with the Cachet-Bonnet anesthesiometer in all subjects. Results: Irritation symptoms correlated with higher log tear fluorescein concentration (symptomatic 3.08 ± 0.62 units/μl, normal control 1.89 ± 0.7 units/μl, P <0.005) and lower Schirmer 1 test scores (symptomatic 12.6 mm, normal control 22.3 mm, P <0.005). The FCT showed greater predictive value for identifying ocular irritation than the Schirmer 1 test. A fluorescein concentration of 274 units/μl eliminated 80{\%} of the normal subjects (specificity) and identified 85{\%} of the abnormal subjects (sensitivity). Log of tear fluorescein concentration and the Schirmer 1 test correlated with meibomian gland orifice metaplasia (2.81 ± 0.78 units/μl and 14.47 ± 9.53 mm in those with metaplasia vs. 1.83 ± 0.71 units/μl and 23.14 ± 7.67 mm in those without metaplasia, P <0.001) and with the percentage of acinar dropout. Both log of tear fluorescein concentration and the Schirmer 1 test correlated with corneal fluorescein staining (Pearson correlation of 0.394 P <0.0001 for Schirmer 1 test and 0.312 P <0.005 for log of tear fluorescein). In addition, log of fear fluorescein and Schirmer 1 test scores correlated with corneal and conjunctival sensation scores (Spearman's rho for corneal sensation: log of tear fluorescein -0.38, P <0.003, Schirmer 1 test -0.39, P <0.002, and for conjunctival sensation: log of tear fluorescein - 0.391, P <0.001, Schirmer 1 test -0.23, P <0.061). Conclusions: The FCT shows a greater predictive value for ocular irritation than the Schirmer 1 test. It correlates better with age, meibomian gland dysfunction, and decreased corneal and conjunctival sensation. Decreased tear clearance was identified as a risk factor for ocular irritation, even in subjects with normal Schirmer scores. This simple technique may provide new clues into the mechanism and therapy of ocular irritation.",
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TY - JOUR

T1 - Correlation of tear fluorescein clearance and Schirmer test scores with ocular irritation symptoms

AU - Afonso, Adolfo A.

AU - Monroy, Dagoberto

AU - Stern, Michael E.

AU - Feuer, William J

AU - Tseng, Scheffer C G

AU - Pflugfelder, Stephen C.

PY - 1999/4/1

Y1 - 1999/4/1

N2 - Objective: To correlate and compare the Schirmer 1 test and a new method of measuring tear fluorescein clearance with the CytoFluor II fluorometer with the severity of ocular irritation symptoms, clinical signs of meibomian gland disease, corneal fluorescein staining scores, and corneal and conjunctival sensitivity. Design: Case-control study. Participants: Forty patients presenting with a chief complaint of ocular irritation, and 40 asymptomatic control subjects of similar age distribution. Intervention: All subjects completed a symptom questionnaire, a baseline ocular examination, fluorescein clearance test (FCT), and Schirmer 1 test. Main Outcome Measures: The FCT was performed with a CytoFluor II fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus 15 minutes after instillation of 5 μl of 2% sodium fluorescein. Severity of ocular irritation was assessed with a symptom questionnaire. Schirmer 1 test, biomicroscopic meibomian gland evaluation, corneal fluorescein staining score, and corneal and conjunctival sensation scores were assessed with the Cachet-Bonnet anesthesiometer in all subjects. Results: Irritation symptoms correlated with higher log tear fluorescein concentration (symptomatic 3.08 ± 0.62 units/μl, normal control 1.89 ± 0.7 units/μl, P <0.005) and lower Schirmer 1 test scores (symptomatic 12.6 mm, normal control 22.3 mm, P <0.005). The FCT showed greater predictive value for identifying ocular irritation than the Schirmer 1 test. A fluorescein concentration of 274 units/μl eliminated 80% of the normal subjects (specificity) and identified 85% of the abnormal subjects (sensitivity). Log of tear fluorescein concentration and the Schirmer 1 test correlated with meibomian gland orifice metaplasia (2.81 ± 0.78 units/μl and 14.47 ± 9.53 mm in those with metaplasia vs. 1.83 ± 0.71 units/μl and 23.14 ± 7.67 mm in those without metaplasia, P <0.001) and with the percentage of acinar dropout. Both log of tear fluorescein concentration and the Schirmer 1 test correlated with corneal fluorescein staining (Pearson correlation of 0.394 P <0.0001 for Schirmer 1 test and 0.312 P <0.005 for log of tear fluorescein). In addition, log of fear fluorescein and Schirmer 1 test scores correlated with corneal and conjunctival sensation scores (Spearman's rho for corneal sensation: log of tear fluorescein -0.38, P <0.003, Schirmer 1 test -0.39, P <0.002, and for conjunctival sensation: log of tear fluorescein - 0.391, P <0.001, Schirmer 1 test -0.23, P <0.061). Conclusions: The FCT shows a greater predictive value for ocular irritation than the Schirmer 1 test. It correlates better with age, meibomian gland dysfunction, and decreased corneal and conjunctival sensation. Decreased tear clearance was identified as a risk factor for ocular irritation, even in subjects with normal Schirmer scores. This simple technique may provide new clues into the mechanism and therapy of ocular irritation.

AB - Objective: To correlate and compare the Schirmer 1 test and a new method of measuring tear fluorescein clearance with the CytoFluor II fluorometer with the severity of ocular irritation symptoms, clinical signs of meibomian gland disease, corneal fluorescein staining scores, and corneal and conjunctival sensitivity. Design: Case-control study. Participants: Forty patients presenting with a chief complaint of ocular irritation, and 40 asymptomatic control subjects of similar age distribution. Intervention: All subjects completed a symptom questionnaire, a baseline ocular examination, fluorescein clearance test (FCT), and Schirmer 1 test. Main Outcome Measures: The FCT was performed with a CytoFluor II fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus 15 minutes after instillation of 5 μl of 2% sodium fluorescein. Severity of ocular irritation was assessed with a symptom questionnaire. Schirmer 1 test, biomicroscopic meibomian gland evaluation, corneal fluorescein staining score, and corneal and conjunctival sensation scores were assessed with the Cachet-Bonnet anesthesiometer in all subjects. Results: Irritation symptoms correlated with higher log tear fluorescein concentration (symptomatic 3.08 ± 0.62 units/μl, normal control 1.89 ± 0.7 units/μl, P <0.005) and lower Schirmer 1 test scores (symptomatic 12.6 mm, normal control 22.3 mm, P <0.005). The FCT showed greater predictive value for identifying ocular irritation than the Schirmer 1 test. A fluorescein concentration of 274 units/μl eliminated 80% of the normal subjects (specificity) and identified 85% of the abnormal subjects (sensitivity). Log of tear fluorescein concentration and the Schirmer 1 test correlated with meibomian gland orifice metaplasia (2.81 ± 0.78 units/μl and 14.47 ± 9.53 mm in those with metaplasia vs. 1.83 ± 0.71 units/μl and 23.14 ± 7.67 mm in those without metaplasia, P <0.001) and with the percentage of acinar dropout. Both log of tear fluorescein concentration and the Schirmer 1 test correlated with corneal fluorescein staining (Pearson correlation of 0.394 P <0.0001 for Schirmer 1 test and 0.312 P <0.005 for log of tear fluorescein). In addition, log of fear fluorescein and Schirmer 1 test scores correlated with corneal and conjunctival sensation scores (Spearman's rho for corneal sensation: log of tear fluorescein -0.38, P <0.003, Schirmer 1 test -0.39, P <0.002, and for conjunctival sensation: log of tear fluorescein - 0.391, P <0.001, Schirmer 1 test -0.23, P <0.061). Conclusions: The FCT shows a greater predictive value for ocular irritation than the Schirmer 1 test. It correlates better with age, meibomian gland dysfunction, and decreased corneal and conjunctival sensation. Decreased tear clearance was identified as a risk factor for ocular irritation, even in subjects with normal Schirmer scores. This simple technique may provide new clues into the mechanism and therapy of ocular irritation.

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