title: Assessment of different wetting time and paper strip size of Schirmer test in dry eye patients.
abstract: OBJECTIVE
  To evaluate the correlation between different wetting time and paper strip size of Schirmer test with anesthesia in dry eye patient. Finally the authors determined the agreement on using the ocular surface disease index (OSDI), index for evaluate the severity of the dry eye patient, compare to the standard Schirmer test with anesthesia.
  
  
  METHODS
  A prospective study was performed in 140 eyes of 70 subjects. All subjects had symptoms of dry eye syndrome which was confirmed by Schirmer test with anesthesia before inclusion. The correlation between Schirmer test with anesthesia at 1, 2, 3 and 4 minutes and standard 5-minute test of both 3 mm and 5 mm width of paper strip was evaluated using intraclass correlation coefficient (ICC). The correlation between clinical questions and Schirmer test was documented in Kappa value.
  
  
  RESULTS
  The ICCs were higher than 0.8 after 2 minutes in both 3-mm and 5-mm width of paper strip. Furthermore, it indicated that cut-off value for diagnosis of severe dry eye was 2.5 mm for 5-mm width of paper strip and 4.25 mm for 3-mm width of paper strip at 2-minute measurement. The association between data from the OSDI and objective data from Schirmer test were analyzed by Kappa statistic and showed poor agreement beyond chance (p = 0.591).
  
  
  CONCLUSIONS
  Our results suggested that shorter wetting time of 2-minute Schirmer test with anesthesia could be used instead of the standard 5-minute test. The authors found that the 3-mm width of paper strip could be used instead of the standard 5-mm width of paper strip as well.
authors.affiliation: Department of Ophthalmology, Phramongkutklao Hospital, Bangkok, Thailand.
authors.forename: Surawoot
authors.initials: S
authors.lastname: Suphakasem
authors.forename: Manapon
authors.initials: M
authors.lastname: Lekskul
authors.forename: Ram
authors.initials: R
authors.lastname: Rangsin
mesh_terms: D000328:Adult; D003941:Diagnostic Techniques, Ophthalmological; D015352:Dry Eye Syndromes / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires