La hiperosmolaridad del film lagrimal en el ojo seco. Tears osmolarity in dry eye. Alejandro J. Dry eye is a complex multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.
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There are two clinical ways to determine the tear film's quantity and quality, 8,9 one is the Schirmer test 10,11 and the other one is the break up time test, 12,13 both susceptible to do at the doctor's office with mild invasion to the patient. There isn't a generalized consensus nor either a standardization of these parameters 11 about the Schirmer test and the break up time 15 in Mexico, so some authors' don't give great importance to them, while some others base their studies on these criteria.
Schirmer test consists on putting a filter paper strip inside the inferior cul-de-sac, between the external half of the inferior palpebral and bulbar conjunctiva, with part of this strip hanging from the eyelid. The expected is the wetting of the strip no more of 15 mm in the first two minutes. The technique consists on putting the patient at the biomicroscope, without air drafts, with the slit lamp, and observing at approximately 10 magnifications so we can see simultaneously the whole cornea.
The patient blinks and we determine how long it takes to appear the first desecation zone. Usually, in the same test, the three values appear at similar times, and frequently in the same spot. Normal values are considered over 15 seconds. Mildly low values go from 11 to 15 seconds, moderately low values from 6 to 10 seconds and very low from 0 to 5 seconds.
The sample was obtained from those patients with less than 13 points in the dry eye questionnaire. The questionnaire used was the Benitez del Castillo questionnaire Table 1. We included all patients without dry eye symptoms with a score lower than 13 points, with any visual acuity and any refraction, and willing to be submitted to the study.
We excluded all patients with dry eye symptoms, with a score higher than 13 points, patients who were unable to submit to the Schirmers test or the break up time test, with allergic response to the fluorescein, and patients using any ocular treatment in the last month. For the making of the Schirmer test, we anesthetized the patients with sodic propacaine, 1 drop in each inferior cul-de-sac and we did the test ten minutes later.
Five minutes later, we extracted the strip and wrote down the millimeters moistened in the part of the strip that wasn't inside the eye. If the 30 mm moistened before the five minutes time had passed, then we extracted the strip and wrote down how long it took. For the tear film break up time test, we put the patient at the biomicroscope, without any air current, with the lid lamp, and looking with 10 magnifications so we could see the whole cornea simultaneously.
The patient was asked to blink and we determined how long it took for the first desecation zone to appear, writing down the number in the data paper. The sample obtained was from patients, men and women, ages going from 18 to 77 years old, with an average of Regarding the Schirmer test, we obtained an average of 8.
In the tear film break up time test, we obtained an average of 7. The results obtained for women and men for the Schirmer test were an average of 8.
For the tear film break up time test, the data obtained was an average of 7. As we can see here, the difference we found in the results for women and men were of no statistical significance Figures Figure 2. Tear film break-up time test. Figure 4. Break up time test. The best quantitative way to measure the tear production is the Schirmer test and the tear film break up time test.
In this study, we chose the type I Schirmer test and the break up time test with local anesthesia, because with anesthesia we can partially isolate the basal secretion from the reflex tearing increasing the sensitivity of our study. For a long time, the values used for the Schirmer test and the break up time test for diagnosis and for investigation purposes have been higher than those we have found in our study. Due to that in our daily practice we started noticing lower values in healthy patients, and since there isn't a consensus about what the normal values should be, we decided to perform this study.
Our study showed lower average values, on our population, than those found in the literature, so it might be interesting to perform further studies in different types of population that may suggests that our values can be related to environmental or racial factors.
The normal Gaussian distribution and the correlation between the two tests make us think that the results are statistically significant. It is also interesting to mention that we didn't find any statistical difference between the two tests, comparing men and women.
The Schirmer and the break up time are very easy to test, inexpensive and do not represent any risk for the patient. Also, when made with an adequate normal standard value, the tests can provide very valuable information for the classification of our dry eye patients. In further studies, we will look for a correlation between these non dry eye patients, the new values we found , conjunctiva cytology and tear osmolarity, so we can try to create a new qualitative, quantitative and histological classification for this group of patients.
Correspondence: Salomon Fermon. Telephone: Fax: E mail: sfermon yahoo. ISSN: Descargar PDF. Fermon a , S.. Ball a , JM. Paulin a , R. Davila a , S. Guttman b. Mexico City. Instituto de Oftalmolog?? Objective: To standardize the Schirmer test I and tear break up time results in a group of healthy people from a Mexican Ophthalmological Hospital.
Method: A Schirmer test and a tear film break up time test were realized in healthy individuals who had filled out a previous dry eye questionnaire. The results were recorded and a statistical analysis was done. Results: We collected data from patients, men and women, with an average age of Regarding the Schirmer test we obtained an average of 8. In the Schirmer test we found an average of 8.
Conclusion: We conclude that in Mexican people, the average of the Schirmer test and break up time test is shorter than other reports. We propose to set a new "normal standard" of the test in order to classify dry eye syndromes.. En cuanto a la prueba de Schirmer se obtuvo un promedio de 8. Palabras clave:. Texto completo. Dry Eye, an update on epidemiology, diagnosis, therapy and new concepts..
Dry eye: prevalence, utilization, and economic implications.. Prevalence and associations of dry eye syndrome in an older population: the Blue Mountains Eye Study.. Prevalence of dry eye among adult Chinese in the Beijing Eye Study.. Wavefront analysis of higher order aberrations in dry eye patients.. Low spatial-contrast sensitivity in dry eyes.. Current patterns in the use of diagnostic tests in dry eye evaluation..
Dev Ophthalmol, 41 , pp. A Review, 70 Optom Vis Sci , pp. Non-invasive tear film break-up time: sensitivity and specificity.. Schirmer test and break-up time of tear film in normal subjects..
Factors influencing the variability of tear film break-up time.. Dessication of the precorneal film. Corneal wetting time, 47 Acta Ophthalmol , pp. The diagnosis and management of dry eye: a twenty-five-year review.. Correlation of the Schirmer 1 and fluorescein clearance tests with the severity of corneal epithelial and eyelid disease.. Cornea Tear breakup dynamics: a technique for quantifying tear film instability..
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PELICULA LAGRIMAL PDF
No hay notas en la diapositiva. Pelicula lagrimal 1. El producto ciones lagrimales. Docente Investigadora, Universidad de La Salle. Aceptado: 4 de septiembre de The objective of this environment. Figura 1. Por otro lado, Carney y cols.