Schirmer test in transplanted submandibular gland: influencing factors and a modified measurement method

To explore a modified Schirmer test for patients with submandibular gland (SMG) transplant.

Thirty-seven patients (39 eyes) with severe keratoconjunctivitis sicca who underwent SMG transplantation in an institutional setting were included. Schirmer test I was performed on each eye under 4 different conditions: (1) Basal condition: a single test at 23°C room temperature after 30 minutes of rest (ST1 results); (2) Physical activity: 6 consecutive tests 0 to 30 minutes after stair climbing (ST2-ST7 results in a time sequence); (3) Glandular massage: 5 consecutive tests 0 to 25 minutes after glandular massage (ST8-ST12 results in a time sequence); and (4) High temperature: a single test at 30°C room temperature (ST13 results). The main outcome measurement was value of Schirmer test.

Compared with the basal condition (median ST1 score was 23 mm), physical activity produced increased ST scores within the first 20 minutes (median ST2 to ST5 scores were 73, 69, 39, and 34 mm, respectively, P < 0.01). At the first 10 minutes after glandular massage, median ST8 and ST9 scores were 72 and 18 mm, respectively (P < 0.01). At 30°C room temperature, median ST13 score was 59 mm (P < 0.01), whereas 20 to 30 minutes after physical activity and 10 to 25 minutes after glandular massage, median ST6 to ST7 and ST10 to ST12 scores were 25, 25, 19, 17, and 21 mm, respectively (P > 0.05).

A basal condition without physical activity or glandular stimulation at a comfortable and stable room temperature could be considered a standardized condition for Schirmer test for patients with SMG transplant.