Schirmer’s Test - An Overview

Introduction

Tears are important. Why? Because they protect our eyes from germs and dust, keep our eyes moist, and even deliver nutrition. But sometimes, a few health problems can make our eyes not produce enough tears, or might make them produce too many! So, how can doctors measure your tears? They use a special test called Schirmer’s test. Let's read how this test is done, who might need it, and what the results mean!

What Is Schirmer’s Test?

Schirmer’s test is a special type of eye check-up that helps doctors see how many tears our eyes can produce. So, why is this test done? Well, some people may have dry eyes or excessive tearing. This test helps to figure out what’s going on with the tear-producing machine, which is the lacrimal gland!

This test was invented by a smart German eye doctor named Otto Schirmer in 1903. This test works using a principle called capillary action. This phenomenon allows the tears to be absorbed by the paper strip, like how it rises in a narrow capillary tube. In Schirmer’s test, the further the water goes, the more tears you’re making!

In this test, the doctor takes a tiny piece of paper called a filter paper strip and gently places it in the lower eyelid of each eye. Then you are asked to close your eyes for a few minutes, and then the doctor checks how many tears the paper has soaked.

Let’s learn step by step how it is done.

How the Test Is Performed?

Schirmer’s test is simple and easy to perform. And guess what? It doesn’t cost much either. What do we need for the test? Just three things: paper strips called Schirmer’s paper strips or filter paper strips (dimensions 5 mm by 35 mm), anesthetic eye drops to make your eyes numb, and a timer to count for 5 minutes. Here's how the procedure for Schirmer’s test goes:

• You will be asked to sit comfortably in a chair.

• The doctor will wash their hands and get the paper strips ready. Each strip is labeled as R (right eye) and L (left eye). The end of the paper is already folded (5 mm) to fit nicely inside the eye.

• Now, you need to look up. The doctor will gently pull the lower eyelid and place the folded part of the strip inside. Don’t worry, it's just a soft tickle.

• Then you will be asked to close your eyes lightly or blink normally. But don’t squeeze or scratch your eyes!

• Sometimes, the doctor may use anesthetic drops so that your eyes don’t get irritated from the paper strip, which can lead to excessive tearing.

• The timer is then started, which is for five minutes.

• After five minutes, the doctor will remove the strips and check how wet they got.

Who Should Have a Schirmer’s Test?

Schirmer’s test is done on people who might have trouble with their tears. Some conditions are:

• Keratoconjunctivitis Sicca: It is also called dry eye syndrome. In this condition, the eyes can’t make enough tears. This can make their eyes feel dry, itchy, or even scratchy, like there’s sand in them. They may also feel a burning sensation, have blurry vision, and feel sensitive to light. Dry eyes may also happen due to aging, a change in climate, eye infections, rheumatoid arthritis, eyelid surgery, if done previously, Sjögren's syndrome, and vitamin A deficiency.

• Older People: People over 50 often get dry eyes. This test might be helpful for them.

• Medication Side Effects: Some medicines can make your eyes drier. This test can help figure out that!

• Tear Overproduction: Yes, some people may make too many tears. This test can help assess that.

• People Who Wear Contact Lenses: If your contact lenses feel uncomfortable. This test can show if dryness is the problem.

Types of Schirmer’s Test

Did you know there are different types of Schirmer’s tests? Yep, not just 1, there are 3! Let’s learn about them.

• Schirmer’s Test Type 1: This is the most common one. This further has two types:

  • Without Topical Anesthetic Application: This one checks how many tears you can make, plus your eye’s natural reaction to the strip.

  • With Topical Anesthetic Application: This checks your regular tear-making ability without any extra reflexes, because the anesthetic drops numb your eyes.

• Schirmer’s Test Type 2: Here, the doctor tickles your nose inside with the cotton swab. And then measure how many tears you make.

• Schirmer’s Test Type 3: In this, you have to look at the bright sunlight for a while, which makes your eyes water. Then, the doctor measures how many tears came out.

How to Prepare for the Test?

Before you take a Schirmer’s test, remember a few things, so the test goes just right.

• Don’t use any eye drops or artificial tears a few hours before the test. This might trick the results!

• If you wear contacts, take them out. Wear your glasses instead.

• Skip eyeliner, mascara, or any eye cream for the day.

• If you have had any eye surgeries, inform your doctor.

• If you are concerned about anything, tell the doctor how you feel.

What Do the Results Mean?

Here’s an interesting fact: the rate of tear production of our eyes is 1 to 2 microliters per minute.

After the test, the doctor will look at how wet the paper strip got.

The Schirmer’s test is negative if the tear production is normal. Here’s the interpretation of the test results:

• 15 mm or More in 5 Minutes: This is a normal value, which means your eyes are making the right amount of tears.

The Schirmer’s test is positive if there is reduced tear production, and the interpretation of the test's results is mentioned below.

• 10 to 15 mm in 5 Minutes: This tells your eyes may be a little dry.

• 5 to 10 mm in 5 Minutes: This means your eyes are moderately dry and may need some help to keep them comfortable.

• 0 to 5 mm in 5 Minutes: This means your eyes are very dry and require treatment to feel better.

Conclusion:

The Schirmer test is an easy and quick way to check if your eyes are making enough tears. If your eyes feel scratchy, dry, or burny, or if you feel something is stuck in them, it is really important to tell a doctor. This quick test can help the doctor figure out what’s wrong, and once they know, they can help your eyes feel better.

Note from iCliniq

If your eyes feel dry, gritty, or itchy, it is super important to see a doctor. They might ask you to do the Schirmer test. But guess what? This test just takes about 5 to 10 minutes and doesn’t hurt at all. Even though this test has been around since 1903, doctors have made it better, and now there are newer tests too. You can always reach out to iCliniq doctors with concerns. We will work together as a team to help you feel better.