Diagnosing Oil vs Water Deficient Dry Eye Using Zone-Quick Test

– Hi, dry eye community. I’m Dr. Brill here in Kansas City, and I see a lot of patients with dry eye. And they have a lot of
times have a question about what type of dry eye do I have? Am I deficient in any aspect of my tears? Well we dry eye doctors
kind of answer this by saying we have two
main types of dry eye. One that is, we call it
aqueous deficiency dry eye, and the other one is
called evaporative dry eye. That really means that you’re
deficient in oils, or lipids. So today we’re gonna
show you how we measure the aqueous deficient dry
eye, with two different tests. One’s called Zone-Quick, and the other one is called Schirmer’s. And today I’m going over how we test this. So, we’ve got the traditional test, called a Schirmer’s test, and it’s not one that we use very often. And we have the other
one called Zone-Quick, and it’s also called
Phenol Red Thread Test. So I’m going to demonstrate
how we use these today, so you’ll know when you see your doctor, are they actually measuring if I’m deficient in the
aqueous, or liquid layer, or the oily layer? So the Zone-Quick test
involves two yellow threads, and I’m actually going
to place one of them over our patient here’s lid, and it’s only a 15 second test. The other one involves a strip
of essentially filter paper, and I’ll open it up in a little bit. And it’s a five minute test. So, what would you rather have, a 15 second test, or a five minute test? We prefer the 15 second test. So let me open this up here, and we’ve got a nice patient here. So it’s got yellow, a
little yellow string. And I’m going to actually pull one out. Alright, I’m gonna put
this little thin thread right on our patient’s eyelid, we’re going to go on the outer part here. Debbie, just look up to
the ceiling if you would. And we’re going to count to 15 here. 10. Okay, it’s 15 seconds. Now, if you can see this, there is a part that is the yellow, and there’s a part that’s
red, on this thread here. I’m going to go ahead and measure that, and just see what her, out of,
what the measurement is here. And so it looks like Debbie’s
Zone-Quick score is 20. She produced 20 millimeters of water, in 15 seconds. Well, let’s make it… Let’s change it a little bit, 13 millimeters of water in 15 seconds. Alright, now if I were
to do the other test, it’s called a Schirmer test, which is more an older test, lot of times it’s done in research. And this is going to stay
on her eye for five minutes, which is extraordinarily long. I might end it earlier if it’s, if it gets watered up right away. So there’s a little bend here, and it’s kind of a measurement on there, so let me go ahead and
bend that over her lid. Okay Debbie, go ahead and
look up to the ceiling again, look straight upwards please. And you can blink any
time you feel like it, but it’ll be a little irritating. Okay look up to the ceiling. Okay, good. So usually, people are
able to tear this up in a matter of seconds, but somebody let’s say
with Sjogren’s syndrome may not tear it up at all,
and they may really be dry. And so, it’s good if
somebody’s totally dry, but it’s irritating enough
that most of the time it’s not very accurate. Of course we could do
this with anesthetic too, but this would be a base. And let’s see how you’re doing here, with watering that up. So, we are not going to make her suffer for the whole five minutes, because that would be cruel
and unusual punishment. So, this is how we, I’m
going to take this out here. So this is how we measure
aqueous deficiency. Fairly straightforward. And, we don’t have to guess. So we like doing scientific method, of all the aspects of analysis
of someone’s tear film, in determination of what’s
the cause of the dry eye, and what can we do about it? Thank you for watching, and this is how to do a
diagnostic measurement of dry eye for aqueous deficiency.

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