The potential influence of Schirmer strip variables on dry eye disease characterisation, and on tear collection and analysis


Purpose: The use of the Schirmer strips (SS) as a tool in the characterisation of dry eye disease, depends upon the quantitative assessment of tear production and constituents. The aim of this study was to ascertain the extent to which the properties of commercially available SS can vary and the way in which this baseline information may relate to their comparability in clinical use. Methods: Five SS were analysed: Clement Clarke®, TearFlo®, Bio Schirmer®, Omni Schirmer® and JingMing®. Various aspects of their physical appearance and physicochemical behaviour were measured, including size, weight, and thickness together with surface morphology (assessed by SEM) and aqueous uptake and release behaviour (including the influence of each strip on protein retention and eluent osmolarity). Results: All physical parameters varied between the strips studied for example the Clement Clark was the largest, thickest, and heaviest strip assessed in this study. SEM images showed that each of the SS had unique surface morphologies. Statistically significant differences among the strips were found for uptake (p = 0.001) and release volume (p = 0.014). Clement Clarke absorbed the highest volume over a fixed time period (23.8. ±. 1.6. μl) and Omni the lowest (19.3. ±. 0.5. μl). Clement Clarke showing the highest eluent osmolarity value (5.0. ±. 0.0. mOsm/L) and TearFlo the lowest (2.8. ±. 0.4. mOsm/L). Conclusion: The five strips investigated in this study indicate that there is no standardisation of commercial strips, despite the fact that the need for standardisation was recognised over fifty years ago. This study provides useful baseline information relating to SS comparability in clinical use.

Publication DOI:
Divisions: Engineering & Applied Sciences > Chemical Engineering & Applied Chemistry
Engineering & Applied Sciences > Aston Institute of Materials Research (AIMR)
Life & Health Sciences > Ophthalmic Research Group
Life & Health Sciences > Optometry
Life & Health Sciences
Life & Health Sciences > Vision, Hearing and Language
Engineering & Applied Sciences
Additional Information: © 2017, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Funding: partially supported by the Xunta de Galicia by a pre-doctoral grant of the Plan I2C 2011–2015 and by Fundación Barrié.
Uncontrolled Keywords: Albumin uptake and release,Dry eye diagnosis,Schirmer strip characterisation,Tear flow measurement,Tear sampling,Ophthalmology,Optometry
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Related URLs: http://www.scop ... tnerID=8YFLogxK (Scopus URL)
https://www.sci ... 2400?via%3Dihub (Publisher URL)
PURE Output Type: Article
Published Date: 2018-02-01
Published Online Date: 2017-09-23
Accepted Date: 2017-09-11
Authors: García-Porta, Nery
Mann, Aisling ( 0000-0002-4075-8831)
Sáez-Martínez, Virginia
Franklin, Val ( 0000-0003-2796-4689)
Wolffsohn, James S. ( 0000-0003-4673-8927)
Tighe, Brian

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