Schirmer’s test

Alternative names
Tear test; Tearing test; Dry eye test

Definition
Schirmer’s test determines whether the eye produces enough tears to keep it moist.

How the test is performed

Schirmer’s test uses paper strips inserted into the eye for several minutes to measure the production of tears. The exact procedure may vary somewhat. Both eyes are tested at the same time. Most often, this test consists of placing a small strip of filter paper inside the lower eyelid (conjunctival sac). The eyes are closed for 5 minutes. The paper is then removed and the amount of moisture is measured. Sometimes a topical anesthetic in placed into the eye before the filter paper to prevent tearing due to the irritation from the paper.

This technique measures basic tear function. Even though this test has been available for over a century, several clinical studies have shown that it does not properly identify a large group of patients with dry eyes.

Newer and better tests of tear production and function are now emerging. One test measures an iron-binding molecule called lactoferrin. The amount of this molecule appears to be closely related to tear production. Patients with low tear production and dry eyes have low levels of this molecule. This test may be especially valuable for patients with dry eyes since it can point to specific treatment strategies for dry eye.

The tears may also be examined for their content of lysozyme, an enzyme normally found in tears.

Another test involves fluorescein eye drops, which contain a dye that is placed in the eye. The dye should drain with the tears through the lacrimal duct into the nose within 2 minutes. If patients do not have enough tears to flush the dye into the nose, this time will be longer. A new test is also available to more accurately measure the flow of dye out of the eye.

How to prepare for the test
Remove contact lenses before the test.

Infants and children:
The preparation you can provide for this test depends on your child’s age, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following:

     
  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel
Some people find that holding the paper against the eye is irritating or mildly uncomfortable.

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

Normal Values
A negative (more than 10 mm of moisture on the filter paper in 5 minutes) test result is normal. Both eyes normally secrete the same amount of tears.

What abnormal results mean
Dry eyes can occur from conditions such as:

     
  • Aging  
  • Dehydration  
  • Corneal ulcers and infections  
  • Eye infections (for example conjunctivitis)  
  • Vitamin A deficiency  
  • Sjogren’s syndrome  
  • Secondary tearing deficiency (associated with disorders such as - lymphoma, leukemia, and rheumatoid arthritis)

The inability of tears to drain into the nose can occur with:

     
  • Some eye infections  
  • Blockage of the tear duct

What the risks are
There are no risks with this test.

Special considerations
Close the eyes gently during the test. Tight closing of the eyes or rubbing the eyes during the test can cause abnormal test results.

Do Not rub the eyes for at least 30 minutes after the test. Contact lenses should be left out for at least 2 hours after the test.

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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