Human tear-production rate from closed-eye Schirmer-strip capillary dynamics

Abstract

A Schirmer tear test (STT) is commonly used to gauge human tear production, especially when dry-eye symptoms present. In an STT, the rounded tip of a standardized paper strip is inserted into the lower fornix of the eye, and the wetted length extending out from the lower lid is recorded after 5min of eye closure. Longer wetted lengths suggest higher tear production rates. To date, however, there is no methodology to transform STT transient wetting lengths into basal tear- production rates. We develop a physical model to elucidate wetting kinetics in a Schirmer strip. Tear evaporation from the exposed portion of the strip and gravity are accounted for. Careful consideration of the initial depletion of tear in the closed-eye tear prism reveals an initial fast increase in wetted length followed by slower growth. Excellent agreement of the proposed model is achieved with experimental observation. When evaporation is negligible, the slow-growth regime exhibits a linear increase of wetted length in time. The linear-length-growth time regime permits simple calculation of quantitative tear-production rates. We suggest measuring several dynamic wetting lengths along a sheathed Schirmer strip and near the 5-min insertion duration followed by fitting to a straight line. The slope of the length-versus-time data gives the basal lacrimal-supply rate.