—I appreciate Dr Lambert's concern for data analysis. While I did not go into detail regarding the diagnosis of conjunctivitis sicca in my nine cases, I stated that all had Schirmer test values of less than 10 mm of wetting in five minutes. I also referred to their subjective symptoms and their response to a tear substitute. Were this the central theme of my study, I would have included such aspects as tear osmolarity and lactoferrin content studies recently reported by Farris1,2 with rose bengal stain, lysozyme content, and electrophoresis (older criteria), which Dr Lamberts does not mention. From his own article, to which he does allude, I might also include the dimensions and qualities of the tear strip as visualized at the slit lamp. Yet the latter, as described by the authors themselves, are even more subjective and variable than are the Schirmer test readings.With
Sisler HA. Conjunctivitis Sicca-Reply. Arch Ophthalmol. 1983;101(3):485. doi:https://doi.org/10.1001/archopht.1983.01040010485036
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