Schirmer test

The Schirmer test is a standardized, non-invasive ophthalmologic examination used for the quantitative assessment of tear production. The method evaluates tear secretion, including both basal and reflex components, and is used in the diagnosis of tear production disorders. The test is indicated in suspected dry eye syndrome, dry keratoconjunctivitis, and in the evaluation of patients with possible Sjögren’s syndrome.

Dry eye disease is a multifactorial disorder of the ocular surface associated with tear film instability, inflammation, discomfort, and/or damage to ocular tissues.

The Schirmer test primarily reflects the aqueous component of the tear film and must be interpreted in correlation with clinical findings and additional ophthalmologic examinations.

Indications

• suspected dry eye syndrome;
• foreign body sensation, burning or ocular discomfort;
• photophobia;
• paradoxical tearing;
• unstable or fluctuating vision;
• suspected dry keratoconjunctivitis;
• evaluation of tear production in autoimmune diseases;
• suspected Sjögren’s syndrome;
• monitoring of patients with tear secretion disorders;
• pre- or post-procedural ophthalmic assessment (as indicated by the physician).

Procedure

A standard Schirmer strip is placed in the lower conjunctival fornix of each eye. The test is performed bilaterally, either simultaneously or sequentially. The patient is asked to gently close the eyes without squeezing or rubbing them.

After 5 minutes, the strips are removed and the length of the moistened area is measured in millimeters. Results are recorded separately for each eye.

The procedure is performed by an ophthalmologist in an ophthalmology setting.

Contraindications

• acute inflammatory diseases of the anterior eye segment;
• significant corneal or conjunctival damage;
• recent ophthalmic surgery (based on medical judgment);
• severe blepharospasm;
• conditions in which the test may worsen ocular status.

The decision to perform the test is made by the ophthalmologist.

Recovery / restrictions

No specific recovery is required.

Temporary effects may include:

• ocular discomfort;
• tearing;
• foreign body sensation.

It is recommended to:

• avoid rubbing the eyes for at least 30 minutes;
• avoid contact lenses for at least 2 hours (or as advised by the physician).

Advantages

• simple and fast diagnostic method;
• non-invasive assessment of tear production;
• useful for diagnosing aqueous-deficient dry eye;
• important in Sjögren’s syndrome evaluation;
• performed on an outpatient basis without special preparation;
• high clinical relevance in ophthalmology.

Sources:

https://www.ncbi.nlm.nih.gov/books/NBK559159/
https://medlineplus.gov/ency/article/003501.htm
https://pubmed.ncbi.nlm.nih.gov/30366798/
https://dansk-oftalmologisk-selskab.dk/wp-content/uploads/2022/06/2022-11-03-Nordic-Guideline.pdf
https://www.tfosdewsreport.org/public/images/TFOS_DEWS_II_Diagnostic_method.pdf
https://www.msdmanuals.com/professional/multimedia/table/eularacr-criteria-for-the-classification-of-primary-sj%C3%B6gren-syndrome