September 17, 2011
Schirmer Test – test of tear production
To minimize reflex tearing, the eyes should not be manipulated before starting this test. There is no contraindication to this test.
The materials used are commercially available Whatman no. 41 filter paper strips 5 mm wide × 30 mm in length, known as Schirmer tear test filter strips.
The patient is seated in a dimly lit room, and the filter paper strips are folded 5 mm from the end. The folded end is placed gently over the lower palpebral conjunctiva at its lateral one-third.
The patient keeps the eyes open and looks upward. Blinking is permissible.
After 5 minutes the strips are removed and the amount of wetting is measured from the folded end. If the strips are completely wetted before 5 minutes, they may be removed prematurely.
A normal patient will wet from 10 to 30 mm in 5 minutes; this is age dependent and decreases after the age of 60 years, but is rarely less than 10 mm in 5 minutes.
Measurements greater than 30 mm at 5 minutes indicate that reflex tearing is intact but not controlled and, therefore, are of little diagnostic value.
Between 10 and 30 mm of tear secretion may be normal, or basal secretion may be low but compensated for by reflex secretion. Values less than 5 mm on repeated testing indicate hyposecretion of basic tearing. There is a 15% chance of diagnostic error in this test.