Schirmer Test for Dry Eye: Procedure, Results and Limitations

We all know that we see the world through our two small eyes. There might be some causes by which it might get infected. If you have dry eyes with insufficient tears, you are on the way to getting eye problems you might not know.

A dry eye can cause a feeling of something in your eye: dryness of tears rapidly, burning, red eyes, sensitivity to light and blurry vision. This can make your eyes feel uncomfortable, and in some, it can also cause vision problems.

The symptoms should be taken care of if you are facing problems. The test that can help you diagnose the proper finding of the syndrome is the Schirmer Test. It's not painful and doesn't use any machines for checkups, which might not cause you to get scared.

Let us learn more about the Schirmer Test, how it's done, how much the test result should be, what precautions are needed to be taken after the test, and what can be diagnosed from the test.

What is Dry Eye?

Our eyes need tears to stay healthy and comfortable. When our eyes don't make enough tears to stay wet or don't work correctly, this is called dry eye. This might make our eyes uncomfortable or cause vision problems.

Causes of Dry Eyes

Dry eyes can be caused by situations such as:

• Ageing: An increase in age shows a decrease in tear production. People over 50 are more likely to experience this.
• Arthritis: Any disorder that affects joints.
• Corneal ulcers and infections: A corneal ulcer, also known as keratitis, is an open sore on the cornea (the transparent part of the eye that covers the iris and the pupil, allowing light to enter). Infections are related to communicable diseases caused by pathogens, bacteria, and viruses.
• Diabetes: High blood sugar levels.
• Eye infections: For example, conjunctivitis
• Sjogren Syndrome: Long-term autoimmune disease that affects the body's exocrine glands (lacrimal and salivary glands).
• Vitamin A deficiency: Lack of vitamin A in blood and tissues.
• Ocular surgery side effects: Surgery like LASIK, PRK, and phacoemulsification
• Secondary to systematic disease: like lymphoma, leukemia, Graft vs. Host disease.

What is the Schirmer Test?

The Schirmer test helps determine whether our eyes are producing enough tears to keep them moist. This test is taken when a person experiences dry eyes or excessive watering of the eyes. It also helps to determine whether the surface dryness is due to reduced tear production from lacrimal glands rather than to some other cause, i.e., blepharitis, meibomitis, or exposure.

A small strip of filter paper, 5 mm wide and 35 mm long, is used and placed inside the lower eyelid for about five minutes to see the level of tear production. The wetted area on the strip shows whether it is normal or abnormal.

Types of Schirmer Tests

There are two main types of test:

1. Schirmer-I Test

This test can be performed with anesthetic drops to the eyes to measure baseline secretion.

2. Schirmer II Test

This test can be performed without anesthetic drops on the eyes, measuring baseline secretion plus reflex production using a nasal stimulant.

Preparation for the Schirmer Test

The ophthalmologist doctor and patients should be prepared with the following things for conducting any of the two tests:

1. Patient History and Symptoms

The ophthalmologist's doctor should check the patient's history and symptoms, including any complaints of dryness, irritation, or vision problems. The patient should also clarify all the details related to the eye problem without hesitation.

2. Materials

The materials needed after the check-up by a doctor should be made ready according to the type of test. The following materials would be used for the test:

• Schirmer Strips: These are sterilized filter paper strips used to measure tear production.
• Timer: A stopwatch or timer to measure the accurate duration of the test.
• Anesthetic Eye Drops: The drop may be used in the case of the Schirmer II Test to reduce discomfort.

3. Avoid Eye Drops and Ointments

The patient should not use eye drops and ointments for at least 24 hours before the test to have an accurate result.

4. No makeup or Contact lenses

No makeup or contact lenses should be worn during the test to prevent contamination of the eyes or obstruction of the results.

Step-by-Step Process of Schirmer Test

The Schirmer test involves placing a filter paper strip under the lower eyelid to measure the wet moisture on paper produced over a set period. The following is the step-by-step process of the Schirmer Test:

Step 1: If the Schirmer I Test is taken, then the anaesthetic eye drops are given to each eye, and we wait for them to dry excess tears. The excess tears are removed before the test is started.

(NOTE: If the patient doesn't need an anesthetic drop, then Step 2 would be Step 1)

Step 2: The patient is let down to sit on a chair and positions their head slightly back.

Step 3: The notch of 5 mm at one end on the strip of filter paper is folded.

Step 4: The folder tip is inserted into the lower lid at the junction of the middle and outer thirds of the lower lid, taking into consideration not to touch the cornea or lashes for the feeling of discomfort in the eyes

Step 5: The nasal stimulant will be used slowly to irritate the nasal mucosa by lightly touching the nostril of the nose with the cotton bud. The irritation of touch provokes the nasolacrimal reflex, causing lacrimal glands to produce tears.

(NOTE: This step can be skipped if the eyes are watery and are not caused by any syndrome blocking the tears.)

Step 6: The patient is asked to keep their eyes closed for 5 minutes.

Step 7: After 5 minutes, the filter is removed and the amount of wetting from the fold is measured in millimeters.

Interpretation of Results of the Schirmer’s Test

Post- Test Care and Recommendations

• Do not rub the eyes for at least 30 minutes after the test.
• Do not wear contact lenses for at least 2 hours after the test.
• Contact the doctor immediately if there are any signs of infection, such as redness or swelling.
• Stay away from smoke, wind, and dust for eye irritation. Use sunglasses for this.
• Stay hydrated by drinking plenty of water so as not to let your eyes dry.
• Follow the schedule appointed for checkups if you are missing any.

Frequently Asked Questions (FAQ’s)

1. What does the Schirmer test measure?

Ans: It measures the amount of tear production in the eye.

2. Is the Schirmer test painful?

Ans: No, the test is not painful but sometimes patients may feel slight discomfort.

3. How long does the test take?

Ans: It takes around five minutes.

4. Are there any side effects of the Schirmer test?

Ans: Side effects are rare but can include mild irritation, redness, or watery eyes. But, this would be resolved a few minutes after the test.

5. What is the normal value of the Schirmer test?

Ans: The normal value is from 10 mm to 15 mm.

6. Can the Schirmer test diagnose all types of dry eye?

Ans: It is useful for diagnosing dry eye syndrome but it might not identify all the underlying causes. For comprehensive analysis, additional tests such as tear breakdown Time (TBUT) and ocular surface staining should be done.

Conclusion

We see the world from it so we must take good care of our eyes. That's why we should check our eyes monthly. Make sure not to have dry eyes or an excessive flow of tears. Dry eyes can lead to vision-related problems. The way to diagnose dry eyes is through the Schirmer Test. With the help of the Schirmer Test, we can analyze the normality or abnormality of the tear production capacity of our eyes. It is easy to take and causes less discomfort.

The test should be done immediately to determine the diagnosis of the condition and why you are having dry eyes. Also, we need to take preventive actions through consultation with our ophthalmologist doctor before it is too late to care. So, yes, you can book an appointment if you are having such a problem. Vision Concern is always available for you to help with your eye care.