Schrimer Scores

[Shell259]

Hi all,
I have posted a similar question so sorry if I’m repeating.
I’m just interested to know if those with MGD have normal schrimer scores? Or if they would be low due to evaporative dry eye?

[Meibum Ian]

I have MGD and very low schirmer scores (and am not alone)

One way this can occur is the inflammation cycle caused by MGD leads to inflammation of the lacrimal gland, leading to decreased tear production. Further to this, the tears that are produced are produced are then themselves inflammatory, causing inflammation of the ocular surface and further amplifying the inflammation cycle.

Not an ideal situation!

[Shell259]

Hi, it kinda sounds like MGD can cause aqueous deficiency then?

[Meibum Ian]

Hi, it kinda sounds like MGD can cause aqueous deficiency then?

Yes, if I understand correctly.

My ophthamologist's report says this: "In summary, I believe this gentleman has rosacea-associated blepharitis with secondary dry eye, i.e. he has both a meibomian gland inflammation causing abnormal mebium secretion and secondary inflammatory aqueous deficiency."

[Meibum Ian]

This article gives a good understanding of the cyclical nature of dry eye, but gets pretty technical: https://bjo.bmj.com/content/100/3/300

[MGD1701]

My understanding
1) most people have both MGD and aqueous deficiency or MGD alone, but aqueous deficiency alone is very rare.

2) ALL with aqueous deficiency, eventually will develop MGD sooner or later, according to Prof. Christopher Starr, MD - an expert on Osmolarity test.

Schirmer test
Almost all opinion doctors in USA do not do it for dry eye as it does not provide useful/reliable info, rather they prefer Osmolarity test.

Some doctors such as Dr Toyos prefers Keratograph 5M.
(kind of LipiView + MMP-9 (debris in the tear?) + osmolarity & more, including
tear meniscus height (tmh) to measure tear volume -
''The DEWS II recommendation is for the tear meniscus height to be measured.
A lower meniscus would indicate a more severe version of aqueous deficiency.”''
tmh can be measured with slit lamp too.

Interestingly, I just learnt recently that a famous dry eye expert mentioned Schirmer is not reliable (could range from 5, 7, 10, 15) but if somone result is always 0, (very) likely has sjogrens.