Survey of oculoplastic surgeons regarding clinical use of tear production tests

To determine by a survey of ophthalmic plastic surgeons with specific expertise in blepharoplasty surgery the perceived role of Schirmer testing and other evaluation features in determining patient predisposition to postoperative dry-eye complaints.

A literature review of tear production tests was performed. An anonymous survey was mailed to all members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. The survey included questions on practice patterns, the role of different objective tests, and the occurrence of postblepharoplasty dry-eye or exposure complaints.

Forty-eight percent (263 of 544) of those surveyed responded. All responding physicians perform a clinical history and examination to preoperatively evaluate for dry eye, 36% perform no additional tear production tests, 33% perform a test if indicated by signs or symptoms, 29% always perform a test, and 1% perform a test only if multiple procedures were planned. Schirmer testing with anesthetic is the predominant test used by physicians who perform tear production tests (89%), followed by Schirmer test without anesthetic (10%), and phenol red thread test (1%). Nevertheless, 74% of physicians felt that Schirmer testing should not be a medical standard of care in evaluating blepharoplasty patients.

The preoperative evaluation of blepharoplasty patients may be severely limited in specialties that perform Schirmer testing or other tear production tests without the benefit of a directed clinical history and slit lamp examination. Current tear production tests are unreliable in detecting dry eye. The ideal approach to the evaluation of the blepharoplasty patient remains controversial.