According to the Copenhagen criteria for Sjogren's syndrome, the diagnosis of keratoconjunctivitis sicca requires the performance of 3 objective ocular tests, with 2 showing pathological results. A common panel is the Schirmer-1 test, the break-up time and Rose-Bengal score. By dividing clinical ophthalmological tests into 3 groups based on the characteristic functions of the lacrimal system, the results of different testing panels can be compared.




Abnormal Result

tear production

Schirmer-1 test

<= 10 mm in 5 minutes


tear lysozyme

<= 1.4 g/L


tear lactoferrin

<= 1.1 g/L


tear IgA

<= 0.8 g/L

tear quality

break-up time

<= 10 seconds



>= 320 mosmol


ferning test


ocular surface

Rose-Bengal score

>= 4 (in range 0-9)



< 30 mm


imprint biopsy p12

positive snake (snake-like chromatin)


Testing protocol:

(1) at least one test in each of the 3 parameters should be performed

(2) 2 of the parameters should be abnormal for the diagnosis of keratoconjunctivitis sicca


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