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Advice on preparations before Schirmer or tear break up please

Posted , 4 users are following.

Tumtum1963
Tumtum1963

I'm having an eye check up on Wednesday with a new optometrist. My previous one used to check my Sicca by doing a tear break up test (or blink test) and my score was always low. But then a new rheumatologist did a Schirmer test on me and they were within normal range. At the time of the Schirmer I was on steroids and they weren't particularly dry. Now they are but I'm not sure whether to stay off Lacrilube and drops until my test is over?

Also it woukd be interesting to know which is the more reliable of these two tests for Sicca? 

0 likes, 8 replies

8 Replies

  • pam_87693
    pam_87693 Tumtum1963

    Posted

    I think it would be wise to stop the drops and lacrilibe the night before. This will give the option plenty of time to see your eye as they are. Retain for any eye make up too as this might mask possible problems. Good luck 🍀
    • Tumtum1963
      Tumtum1963 pam_87693

      Posted

      Thanks Pam - this is really helpful advice. Interesting what you say about the Schirmer test with paper stinging eyes. I found it really painful and told the rheumatology nurse that my optician told me exactly what you've said re tears produced from pain. The tear break up test is completely painless - some dye in the eyes which are examined with a lens to see how fast the tears pass over the surface and how long you can resist blinking for. My optician was quite shocked by my result first time about four years ago - 1 out of ten in one eye and 2 in the other - pathologically dry he said. I've had dry eyes for decades so I was less surprised!
  • jordan58854
    jordan58854 Tumtum1963

    Posted

    I think one test uses numbing drop and the other no numbing drops. I can't remember which is the correct way but I think it is the one with numbing drops because the paper used in the test can sting your eyes and make you tear from pain which is not the tears the test is looking for. I want to suggest to you that if your eyes feel uncomfortable to you, they are dry and that is all that really matters, your comfort. A few tips though. Over the counter drops have enough "junk" in them that they take away from what natural tears your body makes. It is better to just reduce your inflammation with your diet (the anti-inflammatory diet, lots of good water, sleep, less reading by using audiobooks, using a healthy cream like coconut oil, etc. around your eyes to soften the tissue which is also an issue with less tears and learn how to yawn on youtube to produce therapeutic tears and relax your body and mind. Seriously, there are lessons on Youtube that are wonderful how to yawn lessons. Also, take care to reduce your stress. When I have less stress I don't notice the dryness as much. Hope this helped. 
    • Tumtum1963
      Tumtum1963 jordan58854

      Posted

      Oops replied to Pam in answer to your point Jordan!

      Interesting what you say about the Schirmer test with paper stinging eyes. I found it really painful and told the rheumatology nurse that my optician told me exactly what you've said re tears produced from pain. The tear break up test is completely painless - some dye in the eyes which are examined with a lens to see how fast the tears pass over the surface and how long you can resist blinking for. My optician was quite shocked by my result first time about four years ago - 1 out of ten in one eye and 2 in the other - pathologically dry he said. I've had dry eyes for decades so I was less surprised!

      He told me to use lacrilube at night and Hyloforte preservative free drops by day. I get these in prescription - had to be insistent with GP about preservative free though!

  • jordan58854
    jordan58854 Tumtum1963

    Posted

    I also want to mention that I can cry a lot of tears when I see or hear something touching, so the lack of tears on a regular basis is really such a mystery to me--my eyes can get very dry generally. Most importantly, I do not cry or feel stinging when I cut onions, at all, and I always did very easily and painfully so until now.. So onions should really the premier test. It is the best proof I have ever had that the nerves that produce the lubication for my eyes, generally, are not working at all. I think, if you cry when you cut onions you do not have ss. The tears come when I yawn and when I cry which I think relaxes the area to open it up to let the water flow, when generally the affected nerves keep the tears from coming. Hope that helps too.
    • Tumtum1963
      Tumtum1963 jordan58854

      Posted

      I don't cry tears much for any reason now although I was on steroids for six months last year and my eyes became quite gushy again then. I'm a bit complicated with the stress levels presently and am highly allergic to many things so have been on antihistamine - which I think makes them even dryer. No damage to the eye surface at least though so I keep using the ointment and drops.

      I was diagnosed and treated for RA for a few years so very mindful of good diet and use lots of natural skin creams etc. However I have small fibre neuropathy in glove/ stocking distribution and in my face - around my mouth. No one has mentioned this in relation to Sjogrens because I don't have the antibodies and refused the lip biopsy at their advice. My mouth isn't especially dry but I struggle to swallow because of dryness further down and my nose is very dry and bleeds often. Take your point about relaxation exercises and avoiding computers before bed etc. I'm not so good in this regard it's true!

  • jordan58854
    jordan58854 Tumtum1963

    Posted

    Sometimes the dryness in your through can be from a sinus issue or not swallowing enough because your mind is on something else. Since the surfaces of your eyes look good then you are doing okay. The main thing is to remember to put in moisture or yawn and cry, then rub your lids over the surfaces of your eyes. Your diet is good. Reduce that stress although I know it is almost impossible at times. Just today I had a mechanic yelling at me because I needed to know when to get my car. I was so upset after that. Finally got home and got recentered. I don't think your dr sounds very sensitive by saying your eyes are pathologically dry. I had a cornea specialist who use to frighten me. I had to get her out of my life. My new dr is very supportive and comes up with new was to help. Do you know that the top ss doctor is still not sure if ss is really not just an issue with the reduction of hormones in aging people? As far as the lip biopsy, if you are already being monitored for your symptoms and having bloodwork to rule out any related issues, the lip biopsy is just added pain for nothing. Don't forget to put the drops of natural lemon and a few teaspoons of tart cherry juice in water to reduce your inflammation. Get alkaline for your health. Take care of yourself.
    • Tumtum1963
      Tumtum1963 jordan58854

      Posted

      Thanks for all the tips Jordan. Re the monitoring - I sort of self monitor now - blood work hmm - the last GP I asked suggested it was all in my mind so I plan to stay away now! Re drying up as we age - well I was born old then and must be getting younger everyday like Bejamin Button!
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