Schirmer test

Schirmer Test

The Schirmer Test is a clinical procedure used to assess tear production and diagnose dry eye syndrome. This test is named after the German ophthalmologist Otto Schirmer, who introduced it in the early 20th century. It is a simple, diagnostic tool that measures the rate of tear secretion and helps in the evaluation of Sjögren's syndrome, keratoconjunctivitis sicca, and other conditions related to reduced tear production or dry eyes.

Procedure

The Schirmer Test involves placing a small, standardized strip of filter paper at the outer third of the lower eyelid. The patient is asked to close their eyes, and the strip is left in place for five minutes. After the allotted time, the strip is removed, and the amount of wetting (measured in millimeters) is noted. The length of the strip that has become moistened by tears is an indicator of tear production. There are two types of Schirmer Tests:

• Schirmer I Test: Performed without the use of anesthetic drops to evaluate the basic and reflex tear secretion.
• Schirmer II Test: Conducted with anesthetic drops to measure only the basic secretion rate, minimizing reflex tearing.

Indications

The Schirmer Test is indicated for patients presenting symptoms of dry eye syndrome, such as irritation, redness, burning sensation, and blurred vision. It is also used in the evaluation of patients with suspected Sjögren's syndrome, a systemic autoimmune disease that affects the glands responsible for tear and saliva production.

Interpretation

Results of the Schirmer Test are interpreted as follows:

• A wetting length of less than 5 mm in 5 minutes is considered indicative of severe dry eye.
• A wetting length of 5-10 mm suggests moderate dry eye.
• A wetting length of 10-15 mm is considered borderline.
• A wetting length of more than 15 mm is generally considered normal.

Limitations

While the Schirmer Test is a valuable tool in the diagnosis of dry eye conditions, it has its limitations. The test can be influenced by various factors, including patient age, environment, and the presence of contact lenses. Additionally, the test's sensitivity and specificity can vary, making it one component of a comprehensive ophthalmic examination.

Conclusion

The Schirmer Test remains a widely used and important diagnostic procedure in ophthalmology for assessing tear production and diagnosing dry eye-related conditions. Despite its limitations, when combined with other diagnostic tools and a thorough patient history, it provides valuable information in the management of patients with dry eye syndrome and related disorders.