Norm of Schirmer Tearing Eye Test
≥10 mm of moisture from each eye after 5 minutes.
Absent tear production in Sjögren's syndrome.
Reduced tear production in meibomian gland dysfunction.
Usage of Schirmer Tearing Eye Test
Aging that results in tearing, leukemia, lymphoma, Sjögren's syndrome, and rheumatoid arthritis.
Description of Schirmer Tearing Eye Test
The Schirmer test differentiates “keratoconjunctivitis sicca” from abnormal or reduced tearing of the eyes. In normal eyes, both basic and reflex tearing keep the eyes moist. Basic tearing occurs throughout the day, supplying basic essential nutrients and lubricants to the eyes, and reflex tearing occurs in response to eye irritation. Either or both types of tearing capability may be absent or reduced in different disorders and lead to ocular surface damage. The Schirmer tearing eye test involves the simultaneous testing of the tearing ability of both eyes to assess the function of the lacrimal glands. The amount of moisture accumulating on filter paper held against the conjunctival sac is evaluated. Filter paper that remains dry for 15 minutes indicates insufficient tear formation.
Professional Considerations of Schirmer Tearing Eye Test
Consent form NOT required.
- Two sterile strips of filter paper ruled in millimeters.
- Topical anesthetic such as proparacaine.
- To measure the function of accessory lacrimal glands, instill one drop of topical anesthetic into each conjunctival sac before inserting the strips.
- Position the client sitting upright with the head tilted back against a headrest.
- Instruct the client to look upward and gently lower the inferior lids. Hook the folded ends of the filter paper strips over the inferior eyelids at the juncture between the middle and the lateral third.
- After 5 minutes, remove the strips and measure the length of the moistened area in millimeters, starting from the folded ends of the strips.
- The diagnosis of aqueous, tear-deficient dry eye is confirmed if 5 mm or less of tearing is evident on the filter paper.
- Assess for corneal abrasion caused by rubbing the eyes before the topical anesthetic has worn off.
Client and Family Teaching
- This test assesses the tearing ability of the eyes.
- After the test, do not rub your eyes until the topical anesthetic has worn off (usually about 30 minutes). Rubbing the eyes before this time can cause a corneal abrasion, which is painful and takes several days to heal.
Factors That Affect Results
- Rubbing or squeezing the eyes increases tearing.
- The results of the Schirmer test are not consistently reproducible. The test also is not very sensitive for detecting dry eyes. Two additional tests being developed are the tear break-up time (TBUT) test and the fluorescein meniscus time (FMT) test. The TBUT test identifies unstable tears that contribute to dry eye, and the FMT test measures how long it takes for tears to form.
- Drops containing sodium hyaluronidate are sometimes helpful in preventing ocular surface damage from dry eye. Punctal occlusion increases the amount of tears remaining on the eye surface by reducing the rate of tear outflow.
- A modified version of this test is being used experimentally to test for dry mouth, or xerostomia.