Skip to main content
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1999 Jan;83(1):89–91. doi: 10.1136/bjo.83.1.89

Diseases associated with ocular surface abnormalities: the importance of reflex tearing

K Tsubota 1, M Kaido 1, Y Yagi 1, T Fujihara 1, S Shimmura 1
PMCID: PMC1722767  PMID: 10209443

Abstract

AIM—To investigate the correlation between tear function tests and ocular surface integrity in patients with dry eye.
METHODS—297 dry eye patients (55 Sjögren's syndrome, two male and 53 female, average age 52.4 (SD 15.0) years, and 242 non-Sjögren's syndrome, 41 male and 201 female, average age 53.5 (14.1) years) were examined. The following tear function tests were performed: (1) cotton thread test, (2) Schirmer test with topical anaesthesia, (3) Schirmer test without anaesthesia, (4) Schirmer test with nasal stimulation, (5) tear clearance test, and (6) tear break up time (BUT). The ocular surface was evaluated by rose bengal and fluorescein staining. Correlation analysis was performed between each tear function index and vital staining scores.
RESULTS—Among the six tear function tests, the Schirmer test with nasal stimulation correlated most with both of the vital stains (ρ=0.530 for rose bengal and 0.393 for fluorescein). The Schirmer test with or without anaesthesia correlated slightly with rose bengal staining, whereas tear clearance test and tear break up time slightly correlated with fluorescein staining.
CONCLUSION—Vital staining of the ocular surface correlates most with reflex tearing measured by the Schirmer test with nasal stimulation.

 Keywords: tear function; ocular surface; dry eye; reflex tearing

Full Text

The Full Text of this article is available as a PDF (97.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Feenstra R. P., Tseng S. C. Comparison of fluorescein and rose bengal staining. Ophthalmology. 1992 Apr;99(4):605–617. doi: 10.1016/s0161-6420(92)31947-5. [DOI] [PubMed] [Google Scholar]
  2. Feenstra R. P., Tseng S. C. What is actually stained by rose bengal? Arch Ophthalmol. 1992 Jul;110(7):984–993. doi: 10.1001/archopht.1992.01080190090035. [DOI] [PubMed] [Google Scholar]
  3. Fox R. I., Robinson C. A., Curd J. G., Kozin F., Howell F. V. Sjögren's syndrome. Proposed criteria for classification. Arthritis Rheum. 1986 May;29(5):577–585. doi: 10.1002/art.1780290501. [DOI] [PubMed] [Google Scholar]
  4. Hikichi T., Yoshida A., Fukui Y., Hamano T., Ri M., Araki K., Horimoto K., Takamura E., Kitagawa K., Oyama M. Prevalence of dry eye in Japanese eye centers. Graefes Arch Clin Exp Ophthalmol. 1995 Sep;233(9):555–558. doi: 10.1007/BF00404705. [DOI] [PubMed] [Google Scholar]
  5. Lemp M. A. Recent developments in dry eye management. Ophthalmology. 1987 Oct;94(10):1299–1304. doi: 10.1016/s0161-6420(87)80015-5. [DOI] [PubMed] [Google Scholar]
  6. Lemp M. A. Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. CLAO J. 1995 Oct;21(4):221–232. [PubMed] [Google Scholar]
  7. Ohashi Y., Motokura M., Kinoshita Y., Mano T., Watanabe H., Kinoshita S., Manabe R., Oshiden K., Yanaihara C. Presence of epidermal growth factor in human tears. Invest Ophthalmol Vis Sci. 1989 Aug;30(8):1879–1882. [PubMed] [Google Scholar]
  8. Paschides C. A., Petroutsos G., Psilas K. Correlation of conjunctival impression cytology results with lacrimal function and age. Acta Ophthalmol (Copenh) 1991 Aug;69(4):422–425. doi: 10.1111/j.1755-3768.1991.tb02016.x. [DOI] [PubMed] [Google Scholar]
  9. Toda I., Shimazaki J., Tsubota K. Dry eye with only decreased tear break-up time is sometimes associated with allergic conjunctivitis. Ophthalmology. 1995 Feb;102(2):302–309. doi: 10.1016/s0161-6420(95)31024-x. [DOI] [PubMed] [Google Scholar]
  10. Toda I., Tsubota K. Practical double vital staining for ocular surface evaluation. Cornea. 1993 Jul;12(4):366–367. doi: 10.1097/00003226-199307000-00015. [DOI] [PubMed] [Google Scholar]
  11. Tseng S. C. Concept and application of limbal stem cells. Eye (Lond) 1989;3(Pt 2):141–157. doi: 10.1038/eye.1989.22. [DOI] [PubMed] [Google Scholar]
  12. Tseng S. C. Staging of conjunctival squamous metaplasia by impression cytology. Ophthalmology. 1985 Jun;92(6):728–733. doi: 10.1016/s0161-6420(85)33967-2. [DOI] [PubMed] [Google Scholar]
  13. Tsubota K. The importance of the Schirmer test with nasal stimulation. Am J Ophthalmol. 1991 Jan 15;111(1):106–108. doi: 10.1016/s0002-9394(14)76908-9. [DOI] [PubMed] [Google Scholar]
  14. Tsubota K., Toda I., Yagi Y., Ogawa Y., Ono M., Yoshino K. Three different types of dry eye syndrome. Cornea. 1994 May;13(3):202–209. doi: 10.1097/00003226-199405000-00002. [DOI] [PubMed] [Google Scholar]
  15. Tsubota K., Xu K. P., Fujihara T., Katagiri S., Takeuchi T. Decreased reflex tearing is associated with lymphocytic infiltration in lacrimal glands. J Rheumatol. 1996 Feb;23(2):313–320. [PubMed] [Google Scholar]
  16. Ubels J. L., Foley K. M., Rismondo V. Retinol secretion by the lacrimal gland. Invest Ophthalmol Vis Sci. 1986 Aug;27(8):1261–1268. [PubMed] [Google Scholar]
  17. Wilson S. E. Lacrimal gland epidermal growth factor production and the ocular surface. Am J Ophthalmol. 1991 Jun 15;111(6):763–765. doi: 10.1016/s0002-9394(14)76785-6. [DOI] [PubMed] [Google Scholar]
  18. Xu K. P., Yagi Y., Toda I., Tsubota K. Tear function index. A new measure of dry eye. Arch Ophthalmol. 1995 Jan;113(1):84–88. doi: 10.1001/archopht.1995.01100010086025. [DOI] [PubMed] [Google Scholar]
  19. van Bijsterveld O. P. Diagnostic tests in the Sicca syndrome. Arch Ophthalmol. 1969 Jul;82(1):10–14. doi: 10.1001/archopht.1969.00990020012003. [DOI] [PubMed] [Google Scholar]
  20. van Setten G. B., Viinikka L., Tervo T., Pesonen K., Tarkkanen A., Perheentupa J. Epidermal growth factor is a constant component of normal human tear fluid. Graefes Arch Clin Exp Ophthalmol. 1989;227(2):184–187. doi: 10.1007/BF02169794. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES