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    Schirmer's test

    Tear test; Tearing test; Dry eye test; Basal secretion test

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

    How the Test is Performed

    The health care provider will place a special paper strip inside the lower eyelid of each eye, under the eyelid (usually the bottom one). Both eyes are tested at the same time. Before the test, you will be given numbing eye drops to prevent your eyes from tearing due to irritation from the paper strips.

    The exact procedure may vary. Most often, the eyes are closed for 5 minutes. Close your eyes gently. Closing the eyes tightly or rubbing the eyes during the test can cause abnormal test results.

    After 5 minutes, the doctor removes the paper and measures how moist it is.

    Sometimes the test is done without numbing drops to test for other types of tear problems.

    The phenol red thread test is similar to the Schirmer's test, except that red strips of special thread are used instead of paper strips. Numbing drops are notneeded. The test takes 15 seconds.

    How to Prepare for the Test

    You will be asked to remove your contact lenses before the test.

    How the Test Will Feel

    Some people find that holding the paper against the eye is irritating or mildly uncomfortable. The numbing drops often sting at first.

    Why the Test is Performed

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

    Normal Results

    More than 10 mm of moisture on the filter paper after 5 minutes is a sign of normal tear production. Both eyes normally release the same amount of tears.

    What Abnormal Results Mean

    Dry eyes may result from:

    • Aging
    • Blepharitis
    • Climate changes
    • Corneal ulcers and infections
    • Eye infections (for example, conjunctivitis)
    • Laser vision correction
    • Leukemia
    • Lymphoma
    • Rheumatoid arthritis
    • Previous eyelid or facial surgery
    • Sjogren syndrome
    • Vitamin A deficiency

    Risks

    There are no risks with this test.

    Considerations

    Do not rub the eyes for at least 30 minutes after the test. Leave contact lenses out for at least 2 hours after the test.

    Even though the Schirmer's test has been available for more than 100 years, several studies show that it does not properly identify a large group of patients with dry eye. Newer and better tests are being developed. One test measures a molecule called lactoferrin. Patients with low tear production and dry eye have low levels of this molecule.

    Another test measures tear osmolarity, or how concentrated the tears are. The higher the osmolarity, the more likely it is that you have dry eye.

    References

    American Academy of Ophthalmology Preferred Practice Patterns Committee. Preferred Practice Pattern Guidelines. Comprehensive Adult Medical Eye Evaluation. Available at http://one.aao.org/CE/PracticeGuidelines/PPP_Content.aspx?cid=64e9df91-dd10-4317-8142-6a87eee7f517. Accessed February 26, 2013.

    American Academy of Ophthalmology Cornea/External Disease Panel. Preferred Practice Pattern Guidelines. Dry Eye Syndrome. 2008. Updated September 2011. Available at http://one.aao.org/CE/PracticeGuidelines/PPP_Content.aspx?cid=127dbdce-4271-471a-b6d9-464b9d15b748. Accessed February 26, 2013.

    Lemp MA, Foulks GN. Diagnosis and management of dry eye disease. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology.2013 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012:vol 4, chap 14.

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      A Closer Look

        Self Care

          Tests for Schirmer's test

          Review Date: 2/7/2013

          Reviewed By: Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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