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Many docs don’t do Schirmer’s anymore in my area. I had it done on a few occasions with anaesthetic and without. Huge difference 25mn for the raw one and 7mm for the anaesthetic.
Some docs have Keratographs so they can estimate tear meniscus height more precisely. Yet I find they can never tell me what’s a good number to have and studies vary a lot.
Then there is also the osmolarity. But is it also incorporating lipids as well? Since rapid evaporation also can lead to hyper osmolarity.
Another cool one is Phenol Red Thread. Seems like a great alternative to Schirmer’s. Only 15 seconds and much less irritation. However I have not seen any docs who would do this test.
What does your best doctor usually do? What is a good combination of tests? Can we measure anything at home? E.g. buy phenol red test.
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As for Schirmer’s with an anaesthetic. I would imagine it could be a great test: painless, no reflex tearing and fairly short. However, to me it seems sketchy to block sensation and expect basal tear secretion to remain the same. LASIK patients have issues not only with reflex tearing but also basal tear secretion due to corneal sensory nerve damage. Some studies show that topical anaesthetic can reduce tear secretion but the study designs are questionable (example 1).
Some docs have Keratographs so they can estimate tear meniscus height more precisely. Yet I find they can never tell me what’s a good number to have and studies vary a lot.
Then there is also the osmolarity. But is it also incorporating lipids as well? Since rapid evaporation also can lead to hyper osmolarity.
Another cool one is Phenol Red Thread. Seems like a great alternative to Schirmer’s. Only 15 seconds and much less irritation. However I have not seen any docs who would do this test.
What does your best doctor usually do? What is a good combination of tests? Can we measure anything at home? E.g. buy phenol red test.
- - - - -
As for Schirmer’s with an anaesthetic. I would imagine it could be a great test: painless, no reflex tearing and fairly short. However, to me it seems sketchy to block sensation and expect basal tear secretion to remain the same. LASIK patients have issues not only with reflex tearing but also basal tear secretion due to corneal sensory nerve damage. Some studies show that topical anaesthetic can reduce tear secretion but the study designs are questionable (example 1).
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