Dry eye testing with Schirmer’s test

Dry eye syndrome is a common condition caused by either a lack of tear production or a deficiency in the makeup of the tears. While many people experience dry eye symptoms, very few are aware that testing for dry eye is available. So, how do you test for and diagnose dry eyes?

One common method to diagnose dry eye is the Schirmer’s test. It is a quick, simple way to measure your eyes’ moisture level. Read more to learn how the Schirmer’s test works, why it’s performed and how to interpret your results. 

What is the Schirmer’s test?

The Schirmer’s test, named after German medical researcher Otto Schirmer, was created as a way to diagnose dry eye syndrome, although it can also be used to detect an overproduction of tears. (Schirmer’s test is also known as the dry eye test, the tear — or tearing — test and the basal secretion test.)

The eyes’ natural tears are produced by special cells in the conjunctiva and by the lacrimal and meibomian glands. These glands in the eyelids generate and release the oily and watery components of tears that keep the eyes moist and comfortable. They also help flush out debris or foreign bodies that may enter the eye. 

If one or both of these types of glands aren’t working properly, your tears may fail to fully clean or moisturize your eyes. This can lead to redness, burning and grittiness — all symptoms of dry eye syndrome.

A Schirmer’s test is not typically performed during a routine eye check unless the patient exhibits dry eye symptoms or an overproduction of tears.

Why a Schirmer’s test is performed

During an eye exam, your eye doctor will be able to observe dry eye symptoms or, conversely, an overproduction of tears. Conducting a Schirmer’s test will help them determine if there’s a problem and how severe it is.

Once the results of the test are received, your eye doctor will begin investigating the potential cause of your dry or over-tearing eyes and establish a treatment plan.

Potential reasons your eyes are dry:

• Diabetes

• Aging

• Laser eye surgery like cataract surgery or LASIK

• Leukemia or lymphoma

• Certain medications like decongestants or antihistamines 

• Sjogren’s syndrome

• Certain autoimmune diseases like rheumatoid arthritis or lupus

• Vitamin deficiency 

Potential reasons you’re overproducing tears:

• Allergies

• Eye irritation

• Especially cold or windy climate

• Dry eye syndrome (it sounds contradictory, but it’s totally possible) 

• Conjunctivitis (pink eye)

• Common cold

• Reaction to a diuretic or certain sleeping pills

• Blocked tear ducts

• Infection

Who should have a Schirmer’s test?

The Schirmer’s test should be done on individuals who are experiencing dry eye symptoms. The most common of these symptoms include:

• Red eyes

• Gritty, burning or stinging sensation in the eyes

• Tired, strained eyes

• Blurred vision

• Watery eyes

• Discomfort when wearing contact lenses

• Light sensitivity

If you consistently experience one or more of the symptoms listed above, you need to schedule an eye exam so your eye doctor can determine a cause and provide options for relief.

What happens during Schirmer’s test?

When the Schirmer’s tear test is performed, your eye doctor will first apply numbing eye drops in both of your eyes to avoid tearing from irritation during the test itself. They will then place a strip of nontoxic filter paper inside the lower eyelid of each of your eyes. 

Your doctor will instruct you to gently close your eyes for five minutes. As your eyes produce tears, the strips of paper will soak them up, wetting the strip.

After five minutes have passed, the paper strips are removed from the bottom eyelid and the amount of moisture on the strip is measured in millimeters. 

What your Schirmer’s test results mean

According to Johns Hopkins Sjögren’s Center, measurements fewer than five millimeters indicate a deficiency in tear production. The normal amount of tearing is at least 10 millimeters, though results over 15 millimeters can hint at an overproduction of tears.

If your results indicate a lack of tear production, your eye doctor may prescribe eye drops for dry eyes. They may also perform more testing to pinpoint the culprit for your dry eye symptoms. Similarly, if your eyes are watery, your eye doctor will investigate potential causes and establish treatment from there.

READ MORE: Home remedies for dry eyes

Page published on Wednesday, June 9, 2021

Medically reviewed on Tuesday, August 31, 2021