Schirmer's test

How the Test is Performed

The health care provider will place a special paper strip inside the lower eyelid of each eye, under the eyelid (usually the bottom one). Both eyes are tested at the same time. Before the test, you will be given numbing eye drops to prevent your eyes from tearing due to irritation from the paper strips.

The exact procedure may vary somewhat. Most often, the eyes are closed for 5 minutes. Close your eyes gently. Closing the eyes tightly or rubbing the eyes during the test can cause abnormal test results.

After 5 minutes, the doctor removes the paper and measures how moist it is.

The phenol red thread test is similar to the Schirmer's test, except that red strips of special thread are used instead of paper strips, and no numbing drops are needed.

How to Prepare for the Test

You will be asked to remove your contact lenses before the test.

How the Test Will Feel

Some people find that holding the paper against the eye is irritating or mildly uncomfortable. The numbing drops often sting at first.

Why the Test is Performed

This test is used when a person experiences very dry eyes or excessive watering of the eyes.

Normal Results

More than 10 mm of moisture on the filter paper after 5 minutes is a sign of normal tear production. Both eyes normally release the same amount of tears.

What Abnormal Results Mean

Dry eyes may result from:

• Aging
• Blepharitis
• Climate changes
• Corneal ulcers and infections
• Eye infections (for example, conjunctivitis)
• Laser vision correction
• Leukemia
• Lymphoma
• Rheumatoid arthritis
• Previous eyelid or facial surgery
• Sjogren syndrome
• Vitamin A deficiency

Risks

There are no risks with this test.

Considerations

Do not rub the eyes for at least 30 minutes after the test. Leave contact lenses out for at least 2 hours after the test.

Even though the Schirmer's test has been available for more than 100 years, several studies show that it does not properly identify a large group of patients with dry eye. Newer and better tests are being developed. One test measures a molecule called lactoferrin. Patients with low tear production and dry eye have low levels of this molecule.

Another test measures tear osmolarity, or how concentrated the tears are. The higher the osmolarity, the more likely it is that you have dry eye.

Alternative Names

Tear test; Tearing test; Dry eye test; Basal secretion test

References

Foulks GN. Treatment of dry eye disease by the non-Ophthalmologist. Rheum Dis Clin N Am. 2008;34:987-1000.

Tanenbaum M, McCord Jr. CD. Lacrimal drainage system. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 13.

Lemp MA, Foulks GN. Diagnosis and management of dry eye disease. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 14.

Miller D, Schor P, Magnante P. Optics of the normal eye. In: Yanoff M, Duker JS, eds. Ophthalmology. 3rd ed. St. Louis, MO: Mosby Elsevier;2008:chap 4.23.

American Academy of Ophthalmology Preferred Practice Patterns Committee. Preferred Practice Pattern Guidelines. Comprehensive Adult Medical Eye Evaluation. San Francisco, CA: American Academy of Ophthalmology, 2010. Accessed January 17, 2011.

American Academy of Ophthalmology. Cornea/External Disease Panel. Preferred Practice Pattern Guidelines. Dry Eye Syndrome. San Francisco, CA: American Academy of Ophthalmology: 2008. Accessed January 17, 2011.

Tomlinson A, Khanal S, Ramaesh K, Diaper C, McFadyen A. Tear film osmolarity: determination of a referent for dry eye diagnosis. Invest Ophthalmol Vis Sci. 2006;47:4309-4315.

Update Date: 2/10/2011

Updated by: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.