Which test is used to evaluate tear production in suspected Sjogren's syndrome?

• A. Schirmer test
• B. ANA
• C. VDRL
• D. RF

Answer: (A)

Measuring tear production directly tests a hallmark of Sjögren's syndrome: impaired lacrimal gland function leading to dry eyes. The Schirmer test is used for this. A small filter paper strip is placed inside the lower eyelid and left for about five minutes. The strip absorbs tears, and the length of wetting in millimeters reflects tear production. A value of less than roughly 5 mm in five minutes indicates reduced tear production consistent with aqueous tear deficiency from lacrimal gland dysfunction, which supports Sjögren's.

Other tests listed don’t measure tear output. ANA screens for autoantibodies and can be positive in Sjögren's but doesn’t quantify tear production. VDRL checks for syphilis, and RF is a nonspecific marker that can be seen in Sjögren's but again doesn’t assess tear production.