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What is Schirmer Test? Test involves measuring the amount of wetting of a special filter paper (no. 41 Whatman), 5 mm wide and 35 mm long. The Schirmer test is performed to measure the quantity of tears produced by the eyes over a specified period, providing valuable information about tear production and assessing for dry eye syndrome. It helps in differentiating between aqueous-deficient and evaporative forms of dry eye. Types: There are two types of Schirmer Test: A. Schirmer Test-1. B. Schirmer Test-2. A. Schirmer-1 Test: No surface anesthetic drops are used. It measures basic secretion and reflex secretion. Less than 10 mm of wetting after 5 minutes is considered abnormal. B. Schirmer-2 Test: Surface anesthetic drops are used. It measures only basic secretion. Less than 6mm of wetting after 5 minutes is considered abnormal. Schirmer Test Procedure of Schirmer-1 Test: The patient is seated comfortably in an examination chair. Schirmer strip is placed inside the lower eyelid of one eye, typically at the lateral canthus (outer corner of the eye). The patient is instructed to keep both eyes closed for five minutes, allowing tears to accumulate and wet the strip. After the 5min, the strip is removed, and the length of the wet portion (in millimeters) is measured. Interpretation of Schirmer-1 Test: A normal Schirmer test-1 result is typically considered to be greater than 10 millimeters of wetting over five minutes. Reduced tear production, indicated by a Schirmer test-1 result of less than 10 millimeters, suggests decreased tear secretion and may indicate dry eye syndrome. Schirmer test-1 is an essential component of the dry eye evaluation, providing quantitative information about tear production and guiding treatment decisions. Procedure of Schirmer-2 Test: Anesthetic eye drops are instilled into the eye and excess tears are delicately dried. The patient is seated comfortably in an examination chair. Schirmer strip is placed inside the lower eyelid of one eye, typically at the lateral canthus (outer corner of the eye). The patient is instructed to keep both eyes closed for five minutes, allowing tears to accumulate and wet the strip. After the 5min, the strip is removed, and the length of the wet portion (in millimeters) is measured. Interpretation of Schirmer-2 Test: Less than 6mm of wetting after 5 minutes is considered abnormal. Schirmer test-2 assesses basal tear production by suppressing reflex tearing with the use of anesthetic drops. It provides information about tear production independent of reflex tearing, which can be useful in distinguishing between aqueous-deficient and evaporative forms of dry eye. Reduced tear production on Schirmer test-2 suggests inadequate basal tear secretion and may indicate underlying dry eye pathology. Clinical Significance: The Schirmer test is an essential component of the dry eye evaluation, providing quantitative information about tear production. It helps in distinguishing between aqueous-deficient and evaporative forms of dry eye, guiding appropriate management strategies. The test can be repeated over time to monitor changes in tear production and assess the effectiveness of dry eye treatments, such as artificial tears, punctal plugs, and anti-inflammatory medications. Combining the Schirmer test with other diagnostic procedures, such as tear film evaluation, ocular surface staining, and symptom assessment, provides a comprehensive evaluation of dry eye severity and helps tailor individualized treatment plans. Conclusion: In summary, both Schirmer test-1 and Schirmer test-2 are valuable clinical tools for evaluating tear production and diagnosing dry eye syndrome. While Schirmer test-1 assesses overall tear production, Schirmer test-2 provides insight into basal tear secretion by suppressing reflex tearing. These tests play a crucial role in guiding treatment decisions and monitoring patients with dry eye. Check Our Courses: Ophthalmic Instrumentation, Clinical Refraction, Contact Lens, Binocular Vision, Dispensing Optics, MCQs in Optometry Download our App "Optometry Notes & MCQs" from Google Play Store.

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