Francisco, Clarissa R.

OP1-1 CONTACT LENS

SCHIRMERS TEST A test for measuring tear secretion. It is accomplished by using a 35 x 5 mm strip of filter paper. The filter strip is folded so that one end, about 5 mm long, is inserted at the mid-portion (or lateral portion of the lower eyelid of a patient seated in a dimly lit room. Tear secretion is considered normal if 10 mm or more of the paper from the point of the fold becomes wet in a 4-minute period. More than 25 mm of wetting would indicate excessive tear secretion. Without any additional stimulation of any kind the test, called Schirmers test I, measure mainly the basal tear production, but because the filter paper tends to irritate the conjunctiva, some of the reflex tear secretion may be also be measured as well. Schirmers Test II is aimed at measuring mainly reflex tear secretion. It is carried out with the filter paper inserted inside the lower lid of an eye with topical anesthesia, while the contra lateral half of the nasal mucosa is irritated by rubbing it with a dry cotton- tipped applicator. The amount of tear production is measured after 2 minutes. A value of more than 15 mm is considered to be normal and less than 15 mm may indicate a deficiency of reflex tear secretion. FLUORESCEIN TEST A test to assess the fit of hard contact lenses. Fluorescein is instilled between the cornea and the contact lens and under ultraviolet illumination areas where the lens touches the cornea appear purple or blue, whereas areas where there is a space between the lens and the cornea appear yellowish green. This appearance is often referred to as fluorescein pattern BREAK-UP TIME TEST (BUT) A test for assessing the precorneal tear film. Fluorescein is applied to the bulbar conjunctiva and the patient is asked to blink once or twice and then to refrain from blinking. The tear film is scanned through the slit lamp using cobalt blue filter with a wide beam, while the examiner counts or records the time between the last blink and the appearance of the first dry black spot which indicates that the tear film is breaking up. In normal subjects, break up times vary between 15 and 35s. A BUT of 10s or less is abnormal and may be due to mucin deficiency and is often considered to be a negative factor for success in contact lens wear, especially soft lenses. However, this test has been shown to be flawed, because fluorescein can disrupt the teat film.