Korean J Ophthalmol > Epub ahead of print
DOI: https://doi.org/10.3341/kjo.2022.0006    [Epub ahead of print]
Published online May 6, 2022.
The Repeatability, Reproducibility, and Correlation of the Schirmer Test: A Comparison of Open versus Closed Eye
Eren Ekici1, İsmail Çağatay Çağlar2, Esra Ün Akgümüş3
1Department of Ophthalmology, Ankara Ulucanlar Eye Training and Research Hospital
2Department of Ophthalmology, Çorum Hitit University, Faculty of Medicine
3Sungurlu State Hospital, Eye Clinic
Correspondence:  Eren Ekici, Tel: +903123126261, Fax: +903123123805, 
Email: opdrerenekici@gmail.com
Received: 20 January 2022   • Revised: 12 March 2022   • Accepted: 16 March 2022
Abstract
Purpose
To compare the repeatability and reproducibility of the Schirmer test (ST) when the eyes are open (STo) and closed (STc) in previously undiagnosed patients with suggestive symptoms of dry eye.
Methods
In a comparative, observational series case study, 31 patients were included in the study. STo and STc were alternately applied for a total of 6 times. The ST was applied 2 times with the eyes open (S1) and closed (S2) respectively by a single ophthalmologist. Then the ST was repeated four times with the eyes open (S3, S5) and closed (S4, S6) respectively by a single nurse.
Result
s: S1, S3, and S5 were 23.4 mm, 23.7 mm, and 23.3 mm respectively. S2, S4, and S6 were 14.7 mm, 15.6 mm, and 16.6 mm respectively. STc scores were found to be statistically lower than the STo’s in general (right: t = 2.033, P = 0.048; left: t = 3.474, P = 0.004). There was no statistically significant difference in the scores of the 3 tests with open eyes: S1, S3, and S5 (p=0,462). There was also no statistically significant difference in the scores of the 3 tests with closed eyes: S2, S4, and S6 (p=0.05).
Conclusions
Our study suggests that although administering the ST with the patient's eyes open produces higher readings than STc in patients with suggestive symptoms of dry eye; there was an acceptable reliability among tests performed open and closed. Moreover, intra-examiner reliability was higher than inter-examiner reliability for both with the eyes open and closed.
Key Words: Dry eye, Schirmer test, Repeatability, Reproducibility
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