The phenol red thread tear test in large Psittaciformes

OBJECTIVE: To develop a standard method for measuring tear production in large Psittaciformes using the phenol red thread (PRT) tear test. To establish mean PRT tear test values in clinically normal pet birds and to assess the reproducibility of the test. ANIMALS: Two geographically distinct populations of healthy, large Psittaciformes (pilot study and study population). Species groups include: cockatoo (17), macaw (22), Amazon (10), African gray (1), eclectus (1) and pionus (1). PROCEDURE: The PRT was placed under the upper eyelid and both eyelids were held closed throughout the test. The PRT tear test was repeated after 2 months in the pilot study and after approximately 5 min in the study population. RESULTS: The mean PRT tear test values for the pilot study were OD=28.2 mm/15 s (+/- 6.3 mm), OS=24.1 mm/15 s (+/- 6.6 mm) and OD=25.4 mm/15 s (+/- 3.3 mm), OS=25.5 mm/15 s (+/- 5.2 mm), for the first and second visits respectively. The mean PRT tear test value for the study population was: OD=19.8 mm/15 s (+/- 4.3 mm), OS=20.1 (+/- 3.9 mm) and OD=20.0 mm/15 s (+/- 4.5 mm), OS=19.1 mm/15 s (+/- 3.3 mm), for the first and second tests respectively. There was poor repeatability between tests. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that the PRT tear test is a practical method for measuring tear production in large Psittaciformes, although adaptations to the established diagnostic method are necessary to overcome some anatomical differences present in birds. Good reproducibility of the PRT tear test could not be demonstrated in a clinically normal population of birds but geographic location appears to significantly influence results.     

Analysis of tear uptake by the Schirmer tear test strip in the canine eye

OBJECTIVE: To analyze the uptake of tears in a Schirmer tear test (STT) in vitro and in vitro. MATERIALS AND METHODS: Uptake of fluid by Schirmer tear test strips was studied in vitro by examining fluid uptake over time from an unlimited fluid supply as well as with specific fluid volumes applied to the test strip. Uptake of fluid by Schirmer tear test strips was evaluated in a population of 100 ophthalmologically normal dogs together with a group of 40 dogs with tear film abnormalities such as keratoconjunctivitis sicca (KCS) or epiphora. Each animal was given a full ophthalmic examination followed by a standard Schirmer tear test extended over between 3 and 5 min with the STT reading recorded every 5 s and plotted over time. To determine the effect of ocular irritation by the test strip, uptake of tears by test strips was determined before and after topical anesthesia in 20 dogs. RESULTS: In vitro examination of fluid uptake by the STT strips showed an initial rapid uptake followed by a gradual reduction in rate of uptake. Temporal evaluation of STT in vivo showed a similar rapid initial uptake of tear fluid, followed in the majority of cases by a sudden change to a steady state uptake of fluid. The initial gradient was 29.3 +/- 16.9 mm/min followed by a steady state uptake of 5.2 +/- 2.3 mm/min in normal dogs and 1.9 +/- 1.3 mm/min in dogs with KCS. This corresponds to a steady state tear turnover of 7.8 +/- 3.4 microL/min in normal dogs and 2.8 +/- 1.9 microL/min in animals with KCS. Dogs with nasolacrimal blockage and resultant epiphora showed a high initial gradient but final gradients were not statistically different from those of normal dogs. Discussion and conclusions Temporal evaluation of tear uptake by the STT shows substantial differences in rate of tear uptake at different time-points during the period of the test. RESULTS: of this study suggest that the initial rapid rise in STT value represents uptake from the tear lake followed by a slower tear uptake of tears from steady state tear production. Temporal examination of the Schirmer tear test allows a more precise evaluation of tear production than the standard STT measuring tear uptake in 1 min, together with estimation of the contribution to the test strip tear uptake of tears from the residual tear lake volume and those from continual tear production.     

Tear production in canine neonates – evaluation using a modified Schirmer tear test

Purpose The ability of human newborns to produce tears has been a subject of controversy in the literature since the mid‐20th century, and there has been considerable debate as to whether they are able to produce tears. Recently, it was established that total tear secretion (reflex + basal) in full‐term infants is similar to those of adults whereas both reflex and basal tear production is reduced in premature babies. The objectives of this study were to assess whether newborn dogs have measurable aqueous tear production at the fourth week of life and to evaluate a modified Schirmer tear test (mSTT) as a useful method for measuring neonatal tear production in dogs. Methods Thirty four‐week‐old healthy puppies from six litters were evaluated. A control group was composed of 10 normal adult dogs. The mSTT strips were obtained by cutting a 5 mm‐wide strip in half (making two 2.5 mm‐wide strips). The mSTT1 was performed in puppies and adult dogs. Values were compared using t‐tests. Results In neonates, the average value for the mSTT1 was 13.6 ± 3.07 (range = 7–19 mm/min), which was significantly lower in neonates than in adult dogs (23.25 ± 3.5, range = 17–30 mm/min, P < 0.0001). Conclusions Canine neonates do produce tears by the fourth week of life, which can be successfully measured with the mSTT. This report established for the first time that canine neonates have significantly reduced total (reflex + basal) tear secretion compared to adults.     

Effect of acepromazine or xylazine on tear production as measured by Schirmer tear test in normal cats

Objective  To evaluate the effect of acepromazine or xylazine on Schirmer tear test 1 results in clinically normal cats.
Animals  Sixteen healthy cross-breed cats.
Procedure  The animals were randomly divided into two groups of eight cats each. The first group was sedated with acepromazine alone (0.2 mg/kg) and the second group received only xylazine (2 mg/kg). All cats had Schirmer tear test (STT) readings taken prior to sedation and at 15 and 25 min postsedation.
Results  Sedation with acepromazine or xylazine in cats with normal pre-sedation STT 1 values caused a statistically significant decrease in mean values of tear production in both groups. In acepromazine group the mean ± SEM STT at T₁₅ and T₂₅ were 4.31 ± 0.98 ( P  < 0.001) and 5.18 ± 1.07 ( P  = 0.002). The post-treatment mean ± SEM values in xylazine group were 2.18 ± 0.97 ( P  < 0.001) and 2.62 ± 1.17 ( P  = 0.001) at 15 and 25 min respectively. Comparison between T₁₅ and T₂₅ in acepromazine group ( P  = 0.49) and xylazine group ( P  = 0.56) revealed no significant differences.
Conclusion  These observations indicate that both acepromazine or xylazine significantly reduced tear production in clinically normal cats. In cats, clinicians should measure STT values prior to utilizing acepromazine or xylazine as sedatives in order to accurately assess the results. Moreover, sterile ocular lubricant or tear replacement should be used as a corneal protectant during sedation with these drugs.     

Effects of trimethoprim-sulfadiazine on tear production and the fluctuations of Schirmer tear test values in horses

The objectives of this study were to observe the effects of trimethoprim-sulfadiazine on equine tear production and to determine normal fluctuations in Schirmer tear test (STT) values in horses. A randomized, placebo-controlled, blinded clinical trial measuring STT values in 15 horses over an 8-week period was performed. The treatment group (eight horses) received 30 mg/kg trimethoprim-sulfadiazine orally once a day and the control group (seven horses) received placebo (flour) at the same time. All horses were housed outdoors throughout the study. Schirmer tear test values were measured at 0, 2, 4, 6 and 8 weeks, and 4 weeks after discontinuation of treatment. There were no significant differences in tear production between the treated and control groups. Fluctuations in STT were observed and may result from individual and environmental variations. Trimethoprim-sulfadiazine did not decrease tear production in the horses in this study. Horses normally experience periodic fluctuations in STT values.     

Results of Schirmer tear test in clinically normal llamas (Lama glama)

Purpose To determine the normal reference range for Schirmer tear test (STT) values in clinically normal llamas (Lama glama) Animals Nine captive llamas (Lama glama) (seven females and two males) were used in this study. Procedure Complete ophthalmic examinations were performed without chemical restraint. STT I values were evaluated in both eyes of all llamas using a commercial STT strip of a single lot number (Schirmer‐Tränentest^®, Germany). STT II value was also measured in both eyes of seven female llamas. Results No statistically significant differences among ages or between right and left eyes were found for any of the results. The mean ± SD STT I of 18 eyes of nine llamas was 17.3 ± 1.1 mm/min (Range 15–19 mm/min). The mean ± SD STT II of 14 eyes of seven llamas was 15.4 ± 1.7 mm/min (Range 12.5–17.5 mm/min). A paired samples t‐test demonstrated that there was a significant difference between the STT I and II values (P = 0.001). Conclusion This study provides novel data for normal reference ranges of STT I and II values in healthy llamas. Results of this study may assist veterinarians in the diagnosis of ocular surface disease and syndromes affecting the tear film in these species.     

Effects of medetomidine and medetomidine-butorphanol combination on Schirmer tear test 1 readings in dogs

Medetomidine is a commonly used sedative in veterinary medicine whether administered alone or in combination with an opioid such as butorphanol. There are no previous studies that look at the effects of this drug on sequential Schirmer tear test (STT) 1 readings in dogs, including effects on tear production after reversal of the drug. The present study looked at two groups of 10 dogs each that were sedated with intravenous medetomidine or a combination of medetomidine and butorphanol. All dogs had tear readings taken presedation, 15 min postsedation, and 15 min after reversal of medetomidine with atipamezole. Results revealed that intravenous sedation with medetomidine and medetomidine-butorphanol in dogs with no history of ophthalmic disease and presedation STT 1 readings above 15 mm/min, causes a significant decrease in tear production that is measurable at 15 min postsedation. Readings returned to near presedation values within 15 min postreversal in most cases. It is therefore recommended that all eyes be treated with a tear substitute from the time the sedative is given until at least 15 min after reversal.     

Effect of topical 1% tropicamide on Schirmer tear test results in clinically normal horses

Objective  To observe the effect of topical 1% tropicamide on equine tear production as measured by Schirmer I tear test.
Materials and methods  Fourteen adult horses received one drop of 1% tropicamide ophthalmic solution in one eye and the opposite eye served as the control. The tear production in both eyes was tested at 1, 2, 4, 6, and 24 h after 1% tropicamide administration.
Results  Measurements made 1 h after treatment revealed a significant reduction in Schirmer tear test values in tropicamide treated eyes ( P  = 0.002). The observed decrease in tear production was maintained up to 4 h after treatment ( P  = 0.002). Although tropicamide-induced decrease in STT values was observed in the treated eyes, the contralateral eyes did not show significant changes in Schirmer tear test results.
Conclusion  Single dose of topical 1% tropicamide resulted in statistically significant reduction in Schirmer tear test values in clinically normal horses.     

Schirmer tear test results in normal horses and ponies: effect of age,season, environment,sex, time of day and placement of strips

Tear production was evaluated in 39 horses and 29 ponies using Schirmer tear test strips to determine whether diurnal or weekly fluctuations occur, whether location of strip placement has an effect, if values are the same for both eyes in an animal and whether sex, age, stabling vs. pasture and winter vs. summer had an effect. There was no test in which the raw score was less than 10 mm, although there were many occasions where tear wetting exceeded 35 mm. Analysis of the raw (continuous) scores by linear regression provided no evidence that signalment, housing or season or location of strip placement affected results. The distribution of tear test scores for a 'population' of eyes did not differ when the right eye was compared with the left eye or when the same eye was compared at different times on the same day. Individual test wetting values for opposing eyes measured at the same time, and also wetting values for the same eye measured at different times on the same day sometimes differed substantially. In winter maximum tear wetting exceeded 35 mm more frequently in the STT I than in the STT II even in housed horses and ponies, but there was no consistent significant difference. There appears to be wide variability in the STT I in normal horses and ponies.     

Correlation between corneal sensitivity and quantity of reflex tearing in cows,horses, goats,sheep, dogs,cats, rabbits,and guinea pigs

Objective Guinea pigs have a very low threshold of corneal sensitivity and at the same time nearly no reflex tearing compared to dogs, cats, and horses. The question arose whether there is a general correlation between corneal sensitivity and the quantity of reflex tearing. Animals studied Totally 160 animals of 8 different species (20 animals per species) were investigated. Procedures The corneal touch threshold (CTT) was measured with a Cochet–Bonnet esthesiometer. The palpebral fissure length (PFL) was measured with a calliper ruler. The Schirmer tear test (STT) was modified by adapting the width of the STT strip to the PFL of every species. For the STT II, 0.4% oxybuprocaine was applied. Results Corneal touch threshold: Cows (1.67 g/mm²), horses (1.23 g/mm²), sheep (1.13 g/mm²), goats (1.44 g/mm²), dogs (2.16 g/mm²), and cats (1.33 g/mm²) show similar CTT values. In contrast, rabbits (6.21 g/mm²) and guinea pigs (7.75 g/mm²) show a significantly lower CTT. Tear Production Difference STT I ? STT II: Rabbits have the greatest decline in tear production with 38.4%, followed by sheep (33.3%), dogs (31.1%), cats (24.7%), cows (23.7%), horses (18.0%), and goats (14.0%). Guinea pigs have no decline, but a slight increase of ?16.0%. Correlation CTT and STT II ? STT I Difference: Pearson’s correlation coefficient shows a small, but significant correlation. The coefficient of determination can only forecast a value with 7.1% certainty. Conclusions The high variance and low reproducibility of results suggest that the measuring devices are inappropriate to assess the evaluated parameters. Therefore, no assured correlation between the corneal sensitivity and the quantity of reflex tearing could be found.     

Measurement of phenol red thread tear test in Arabian and throughbred horses

Objective To determine physiologic levels of tear production in Arabian (AH) and throughbred horses (TH) by using phenol red thread test (PRT). Animals studied The study was performed on 16 AH and 14 TH, ranging from 2.5 to 24 years of age, housed in a stable situated in the Sanliurfa of Turkey. Procedures For the measurement of PRT, the strip was placed under the lower eyelid approximately one‐third the distance from the temporal to nasal canthus and left for 15 s. The length of the wet area was measured in mm and compared among breed, sex, and age groups and between eyes of both sides. Results The mean length of the wet area was in AH and TH were 30.22 ± 0.99 mm ranging from 16 to 41 and 31.00 ± 1.4 mm ranging from 14 to 47, respectively. There were no significant differences in tear production among breed, sex, or age groups. The values measured for left eyes were significantly higher than those for right eyes (P < 0.05). Conclusions Phenol red thread test measurement is easily used, with no pain, and a comfortable method. PRT can be used in equine ophthalmology on a routine basis to the measurement of tear production. These normal PRT values help diagnosis keratoconjunctivitis sicca in horses.     

Schirmer tear tests and intraocular pressures in conscious and anesthetized koalas (Phascolarctus cinereus)

Objective To estimate mean Schirmer tear test (STT) and intraocular pressure (IOP) values in healthy koalas both conscious and anesthetized. Methods Data were gathered from koalas in Victoria, Australia. Conscious examinations were performed on captive koalas. Free‐ranging (wild) koalas were examined under anesthesia. Anesthesia was induced using alfaxalone, and animals were maintained on oxygen and isoflurane if required. All animals were healthy and had no surface ocular pathology detectable during slit lamp biomicroscopy. STT I tests were performed using commercial STT test strips placed in the lower fornix for 1 min. IOP was measured using an applanation tonometer after topical anesthesia. The higher value of the two eyes for both STT and IOP was analyzed. STT was measured in 53 koalas (34 conscious, 19 anesthetized) and IOP was measured in 43 koalas (30 conscious, 13 anesthetized). A two‐sample t‐test was used to compare means. A P‐value <0.05 was regarded as significant. Mean ± SD is presented. Results The mean higher STT in conscious koalas was 10.3 ± 3.6 mm wetting/min and in anesthetized koalas it decreased to 3.8 ± 4.0 mm wetting/min (P < 0.0001). The mean higher IOP in conscious koalas was 15.3 ± 5.1 mmHg, and in anesthetized koalas it was 13.8 ± 3.4 mmHg (P = 0.32). There was no effect of sex on either STT or IOP. Conclusions The mean and SD of STT and IOP values for koalas both conscious and anesthetized were reported. The mean STT was significantly reduced by alfaxalone anesthesia.     

Intraocular pressure and Schirmer tear test results in clinically normal Long-Eared Hedgehogs (Hemiechinus auritus): reference values

Objective The present study was undertaken to establish reference values for Schirmer tear test (STT) and intraocular pressure (IOP) in the long‐eared hedgehog (Hemiechinus auritus). Animals Fourteen healthy long‐eared hedgehogs (H. auritus) of either sex were studied. Procedures The hedgehogs were individually immobilized with an intramuscular injection of combined Ketamine (20 mg/kg) and Diazepam (0.5 mg/kg), and each animal underwent ophthalmic examinations including: STT, tonometry, biomicroscopy, and indirect ophthalmoscopy. Results No significant effects of animal gender, weight, side (right vs. left eye) were found in this study. Mean (SD) STT values for all eyes (n = 28) were 1.7 ± 1.2 mm/1 min with a range of 0–4 mm/1 min. Mean STT in male animals was 2.2 ± 1.2. Mean STT in female Hedgehogs was 1.3 ± 1.1. Mean (SD) IOP values by applanation tonometry were 20.1 ± 4.0 mmHg (range 11.5–26.5 mmHg). Mean (SD) IOP values by applanation tonometry were 18.2 ± 4.0 and 22.0 ± 3.2 mmHg for males and females, respectively. Conclusions This study reports STT and IOP findings in long‐eared hedgehogs (H. auritus).