Schirmer Tear Production Measurement

Overview:

The Schirmer test is a straightforward and essential diagnostic tool used to measure tear production and assess whether the eyes produce an adequate volume of tears. It plays a key role in identifying aqueous-deficient dry eye, one of the two primary types of dry eye disease (DED).

This test helps determine if reduced tear secretion is contributing to symptoms such as dryness, irritation, burning, or blurred vision.

What Does the Schirmer Test Measure?

The Schirmer test evaluates the aqueous (watery) layer of the tear film, which is produced by the lacrimal glands and is responsible for hydrating and nourishing the ocular surface.

Low tear production can result in:

• Ocular surface dryness and inflammation

• Increased risk of corneal damage

• Discomfort during blinking or contact lens wear

• Compromised visual quality

Schirmer Test Procedure

The Schirmer test is performed in-office and takes approximately 5 minutes:

1. Preparation:

   • The patient is seated comfortably with eyes closed.

   • A small, sterile strip of filter paper is placed inside the lower eyelid (usually the outer third of the eyelid).

2. Measurement Time:

   • The patient keeps their eyes gently closed for 5 minutes.

   • After 5 minutes, the paper is removed and the length of moisture is measured in millimeters.

3. Interpreting Results:

   • >10 mm wetting: Normal tear production

   • 6–10 mm: Mild to moderate aqueous deficiency

   • <5 mm: Indicative of significant aqueous-deficient dry eye

Why It Matters

The Schirmer test provides:

• Objective measurement of tear production

• Confirmation of aqueous-deficient dry eye, often seen in conditions like Sjögren’s syndrome

• Baseline data to track response to treatments (e.g., prescription drops, punctal plugs, autologous serum)

• Guidance for treatment customization—particularly for patients with minimal natural tear volume

Better Insights Lead to Better Outcomes

Understanding how much moisture your eyes naturally produce is crucial for accurate dry eye diagnosis and effective treatment. The Schirmer test offers a quantitative foundation for identifying tear deficiency and planning therapies that truly address the cause—not just the symptoms.

If you're experiencing dry, irritated, or tired eyes, talk to your eye care provider about whether Schirmer testing is right for you.