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Understanding Schirmer’s Test for Dry Eye Diagnosis

Schirmer’s test is essential in diagnosing dry eye by measuring tear production. Understanding this test can lead to better ocular health and comfort.

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Understanding Schirmer’s Test for Dry Eye

Schirmer’s test is a simple, noninvasive diagnostic procedure that measures tear production to help determine the presence and severity of dry eye. It plays a crucial role in assessing whether your eyes produce enough moisture to keep them comfortable and healthy. When our eye doctors suspect dry eye syndrome, they may recommend this test as part of a comprehensive evaluation of the tear film and ocular surface.

What Is Schirmer’s Test?

The Schirmer’s test is designed to evaluate the quantity of tears produced by the eyes. This test uses a small strip of specialized filter paper that is placed under the lower eyelid. By measuring how much the paper becomes moistened over a period—typically 5 minutes—the test provides an indication of aqueous tear production, which is critical for maintaining a healthy ocular surface.

When performed correctly, a Schirmer’s test can help determine whether a patient’s tear production is adequate. Generally, more than 10 millimeters of wetting on the paper within 5 minutes is considered normal, whereas 5 millimeters or less strongly suggests decreased tear production and possible dry eye disease.

How Is the Schirmer’s Test Performed?

During the Schirmer’s test, our eye doctors place a small strip of filter paper inside the lower eyelid of each eye. The test is typically completed over the course of 5 minutes. Depending on the specific approach your doctor chooses, numbing drops may be administered to reduce discomfort and minimize reflex tearing induced by irritation, or the test is performed without anesthesia to assess both basal and reflex tear production.

Here’s what you can expect during the test:

  • Preparation: You will be asked to remove your glasses or contact lenses. If numbing drops are used, they may cause a brief stinging sensation.
  • Test Procedure: The doctor gently inserts the rounded end of the filter paper into the lower fornix (the area between the eyeball and the lower eyelid) of both eyes. It is important that you keep your eyes gently closed during the 5-minute period to allow the paper to absorb the tears naturally.
  • Measurement: After 5 minutes, the strips are removed and the length of the wet portion is measured in millimeters. A reading of more than 10 mm signals normal tear production, while 5 mm or less indicates reduced aqueous secretion consistent with dry eye.

This easy-to-perform test has been used for over 100 years, making it one of the longest-standing methods for assessing tear production.

Contact us today to find a top optometrist near you who can perform Schirmer’s test and help manage your dry eye symptoms.

Interpreting the Results of Schirmer’s Test

The measurement provided by the Schirmer’s test is a key indicator of tear production. Depending on the degree of moisture absorbed by the filter paper, your doctor can determine whether your eyes are producing an adequate amount of tears.

Common interpretations include:

  • Normal Tear Production: More than 10 mm of wetting indicates that the tear film is likely sufficient to maintain ocular surface comfort and health.
  • Borderline Values: Results that fall between 5 mm and 10 mm may indicate a mild to moderate level of tear deficiency. In these cases, your eye doctor may consider other clinical tests or a review of your symptoms.
  • Severely Reduced Tear Production: Less than 5 mm of wetting in 5 minutes is a sign of significantly decreased tear production. This result often confirms the diagnosis of dry eye syndrome and may require targeted management.

It is important to remember that other factors, such as reflex tearing due to irritation from the paper strip, can sometimes alter the outcome. This is one reason why some clinicians debate the use of anesthetic drops during the test.

Controversies and Limitations of the Schirmer’s Test

While Schirmer’s test remains a widely used method, it is not without its limitations. Several factors can influence the test’s accuracy:

  • Reflex Tearing: The insertion of the paper strip can irritate the eye, leading to reflex tearing. This extra tear production does not reflect the baseline, natural tear secretion that is necessary for the ocular surface’s health.
  • Use of Anesthetic: Many clinicians choose to perform the test without anesthetic drops to capture the combined effect of basal and reflex tear production. However, some feel that using an anesthetic provides a more accurate measure of basal secretion. Research has shown that anesthetic drops can significantly reduce tear production, potentially leading to a lower reading.
  • Repeatability and Reliability: Studies have often reported that the Schirmer’s test suffers from a lack of sensitivity, specificity, and reproducibility. Small variations in technique, environmental conditions, or even the patient’s state of relaxation can affect the outcome.

Due to these limitations, newer diagnostic methods such as tear osmolarity measurements and non-invasive tear break-up time (TBUT) assessments are becoming more popular. However, the Schirmer’s test continues to be a useful, accessible tool in many clinical settings.

Understanding Schirmer’s Test for Dry Eye Diagnosis

Contact us today to find a top optometrist near you who can perform Schirmer’s test and help manage your dry eye symptoms.

Common Questions

Schirmer’s test measures tear production to diagnose dry eye syndrome, using a small strip of filter paper placed under the eyelid.
A filter paper strip is inserted under the lower eyelid for 5 minutes, and the wetting length is measured to assess tear production.
More than 10 mm of wetting indicates normal tear production, while less than 5 mm suggests severe tear deficiency.
Yes, factors like reflex tearing and technique variations can affect accuracy, prompting use of additional tests for thorough evaluation.
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Understanding Schirmer’s Test for Dry Eye Diagnosis

Assess tear production and dry eye symptoms with Schirmer’s test. Consult top eye doctors for accurate evaluations and treatment options.

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