A simple method (Schirmer IV) to stimulate reflex tear volume secretion by application of gel ice pack on the closed eyelid in dry eye patients

Objectives: We aimed to demonstrate the effectiveness of gel ice pack application on closed eyelids to stimulate reflex tear volume secretion in dry eye patients. Materials and Methods: It is a randomized and controlled study. Sixty patients with dry eyes were randomized into two groups of 30 each: Group A (gel ice pack) and Group B (control group, gel pack at room temperature). Tear secretions using a Schirmer strip were measured before and after the gel pack applications and compared. Results: The study groups ( n = 30 in each) were comparable in terms of baseline characteristics such as best-corrected visual acuity ( P > 0.05), intraocular pressure ( P > 0.05), and baseline tear volume ( P > 0.05). In terms of Schirmer’s reading at 5 min, the application of gel ice pack resulted in a significant increase in lacrimation in Group A (25.77 ± 10.76 for right eye [OD] and 26.43 ± 10.67 for left eye [OS]) when compared to Group B (13.43 ± 3.98 for OD and 13.80 ± 4.55 for OS) in the overall patient population ( P < 0.001). The pain score (1–5) was slightly higher in the Group A (1, 1, 0–1) when compared to the control group (0, 0, 0–0), which is statistically significant ( P < 0.05). No other adverse events were seen in any of the groups. Conclusion: The gel ice pack application on closed eyelids to stimulate reflex tear secretion is a simple, safe, inexpensive, non-invasive, and feasible procedure. Hence, the application of a gel pack (Schirmer IV) stimulate the reflex tear volume secretions could be considered as one of the methods to measure the reflex tear volume secretions.