Synonym/Acronym:
N/A
Rationale
To assess tear duct function.
Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.
Normal Findings
Critical Findings and Potential Interventions
N/A
(Study type: Sensory, ocular; related body system: Nervous system.)
The tear film, secreted by the lacrimal, Krause, and Wolfring glands, covers the surface of the eye. Blinking spreads tears over the eye and moves them toward an opening in the lower eyelid known as the punctum. Tears drain through the punctum into the nasolacrimal duct and into the nose. The Schirmer tear test simultaneously tests both eyes to assess lacrimal gland function by determining the amount of moisture accumulated on standardized filter paper or strips held against the conjunctival sac of each eye. The Schirmer test measures both reflex and basic secretion of tears. The Schirmer II test measures basic tear secretion and is used to evaluate the accessory glands of Krause and Wolfring. The Schirmer test is performed by instilling a topical anesthetic before insertion of filter paper. The topical anesthetic inhibits reflex tearing of major lacrimal glands by the filter paper, allowing testing of the accessory glands. The Schirmer II test is performed by irritating the nostril with a cotton swab to stimulate tear production.
In many cases, the discomfort caused by a tearing deficiency or related inflammation, also known as “dry eye,” can be treated successfully either with over-the-counter eyedrops or prescription eyedrops. Other, more invasive resolutions include the insertion of punctal plugs to help tears remain on the surface of the eye longer or by expression of the meibomian glands to release the oily meibum required to prevent rapid tear film evaporation. Both procedures can be completed during an office visit. Punctal plugs are small, sterile, biocompatible medical devices that are inserted into the puncta (drainage duct openings in the inner corners of the upper and lower eyelids) to prevent draining of tears from the eye. Temporary plugs are made of dissolvable collagen material, and permanent plugs are usually made of silicone or acrylic material; the placement of the plug also determines the length of time the plug remains inside the duct and whether removal, if needed, would require a surgical procedure. Expression of the meibomian glands is required when the openings of the glands become occluded and a condition called evaporative dry eye develops. The procedure to unblock the meibomian glands, which are located along the edge of the eyelids near the base of the eyelashes, begins with application of warm compresses to the eyelids, after which forceps are used to manually express any hardened substances obstructing the openings of the meibomian glands. Significant pressure must be applied to the eyelids, and this procedure may be considered quite uncomfortable by the patient. There is an automated, in-office treatment for meibomian gland expression; it is reported to produce good results with less discomfort but may not be covered by health insurance.
Factors that may alter the results of the study
Abnormal Findings In:
Teaching the Patient What to Expect
Procedural Information
Potential Nursing Actions
Avoiding Complications
Treatment Considerations
Clinical Judgement
Followup Evaluation and Desired Outcomes
Schirmer Tear Testis the Nursing Central Word of the day!