Objective 4b Break Up Time Test

Question 1

What are the first 5 steps in the Tear Break up test?

Answer 1

1. Wash hands
2. Clean chin and head rest with alcohol
3. Instill fluorescein in each eye
4. Properly position the patient at the slit lamp
5. Focus on the limbus and then move the beam onto the cornea

Question 2

What are the next 5 steps?

Answer 2

6. Hold the joystick all the way back then slowly move it forward to focus
7. Always keep two hands on the slit lamp
8. Use a wide beam diffuse illumination
9. Ask the px to blink a few times then hold their eyelids open
10. Count the number of seconds it takes for the first “black holes” to appear in the fluorescein

Question 3

What is considered a normal value for a tear break up test?

Answer 3

Minimum 10-15 seconds

Question 4

What is considered a normal value in extremely dry environments?

Answer 4

8-10 seconds

Question 5

What does a poor tear break up time imply?

Answer 5

The likelihood of success decreases (inadequate mucin formation in the tear film)

Question 6

How do you check for good tear volume?

Answer 6

By observing the pooling of stained tears where the lower lid meets the globe.
(This is qualitative, but a near absence of fluorescent glow will be an indication that there may not be enough tear volume for contact lenses to be considered.)

Question 7

What else are you observing in the tears?

Answer 7

Debris, mucus and corneal filaments, corneal abrasions, punctate staining (especially at 3 and 9 can be a sign of dryness and poor oxygen supply.)