Sjögren's syndrome other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]


The most commonly used tests for dry eyes of Sjögren's syndrome include Schirmer's test, ocular surface staining and tear break-up time.

Other diagnostic studies

  • The most commonly used tests for dry eyes of Sjögren's syndrome include:[1][2][3][4][5][6]
    • Schirmer's test
      • A folded test strip of sterile filter paper is placed on the margin of each lower eyelid at the junction of the middle and lateral thirds. Ask the patient to close eyes gently for five minutes then the extent of wetting is measured. Wetting of less than 5 mm is demonstrative of tear deficiency and it is a classification criteria for Sjögren’s syndrome.



  • It is performed to evaluate tear stability by staining the tear film with one drop of fluorescein dye and measuring the time in seconds for a dry spot. Tear break-up time ≤10 seconds is indicative of a tear deficiency.



  1. Afonso AA, Monroy D, Stern ME, Feuer WJ, Tseng SC, Pflugfelder SC (April 1999). "Correlation of tear fluorescein clearance and Schirmer test scores with ocular irritation symptoms". Ophthalmology. 106 (4): 803–10. doi:10.1016/S0161-6420(99)90170-7. PMID 10201606.
  2. "Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007)". Ocul Surf. 5 (2): 108–52. April 2007. PMID 17508118.
  3. Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, Lemp MA, Sullivan DA (March 2011). "The international workshop on meibomian gland dysfunction: executive summary". Invest. Ophthalmol. Vis. Sci. 52 (4): 1922–9. doi:10.1167/iovs.10-6997a. PMC 3072157. PMID 21450913.
  4. Whitcher JP, Shiboski CH, Shiboski SC, Heidenreich AM, Kitagawa K, Zhang S, Hamann S, Larkin G, McNamara NA, Greenspan JS, Daniels TE (March 2010). "A simplified quantitative method for assessing keratoconjunctivitis sicca from the Sjögren's Syndrome International Registry". Am. J. Ophthalmol. 149 (3): 405–15. doi:10.1016/j.ajo.2009.09.013. PMC 3459675. PMID 20035924.
  5. van Bijsterveld OP (July 1969). "Diagnostic tests in the Sicca syndrome". Arch. Ophthalmol. 82 (1): 10–4. PMID 4183019.
  6. Bron AJ, Evans VE, Smith JA (October 2003). "Grading of corneal and conjunctival staining in the context of other dry eye tests". Cornea. 22 (7): 640–50. PMID 14508260.