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Schirmer test = 0,00 in Sjögren's syndrome. The test works by the principle of capillary action, which allows the water in tears to travel along the length of a paper test strip in an identical fashion as a horizontal capillary tube. The rate of travel along the test strip is proportional to the rate of tear production.
TBUT test was first described by Norn MS, and then revised by Lemp and Holly. [3] The conventional and most common TBUT measurement method is using slit lamp and sodium fluorescein. Noninvasive instruments (Oculus Keratograph 5M, Germany; K5) are used for automatic non-invasive tear breakup time (NIBUT) measurements. [4]
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Perform a contact/applanation tonometry. Perform a Schirmer's test (The Schirmer's test is sometimes used with a topical eye anesthetic, sometimes without. The use of a topical anesthetic might impede the reliability of the Schirmer's test and should be avoided if possible.).
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Learning effect: new patients improve as more tests are performed due to understanding of the test conditions. Consider the third test as the baseline result [23] Potential for artefacts (i.e. uncharacteristic vision loss) (fig. 6). Below is a list of possible artefacts and a representation of how they may appear.