Schirmer's test

Schirmer's test, placing the strip in the lower eyelid pouch

Schirmer's test determines whether the eye produces enough tears to keep it moist. This test is used when a person experiences very dry eyes or excessive watering of the eyes. It poses no risk to the subject. A negative (more than 10 mm of moisture on the filter paper in 5 minutes) test result is normal. Both eyes normally secrete the same amount of tears.

It is named for Otto Schirmer.[1]

Test procedure

Schirmer test = 0,00 in Sjögren's syndrome

Schirmer's test uses paper strips inserted into the eye for several minutes to measure the production of tears. The exact procedure may vary somewhat. Both eyes are tested at the same time. Most often, this test consists of placing a small strip of filter paper inside the lower eyelid (inferior fornix). The eyes are closed for 5 minutes. The paper is then removed and the amount of moisture is measured. Sometimes a topical anesthetic is placed into the eye before the filter paper to prevent tearing due to the irritation from the paper. The use of the anesthetic ensures that only basal tear secretion is being measured.

This technique measures basic tear function.

A young person normally moistens 15 mm of each paper strip. Because hypolacrimation occurs with aging, 33% of normal elderly persons may wet only 10 mm in 5 minutes. Persons with Sjögren's syndrome moisten less than 5 mm in 5 minutes.

How to read results of the Schirmer's test:

1. Normal which is ≥15 mm wetting of the paper after 5 minutes.
2. Mild which is 14-9 mm wetting of the paper after 5 minutes.
3. Moderate which is 8-4 mm wetting of the paper after 5 minutes.
4. Severe which is <4 mm wetting of the paper after 5 minutes.

Alternatives to Schirmer's test

Even though this test has been available for over a century, several clinical studies have shown that it does not properly identify a large group of patients with dry eyes. Newer and better tests of tear production and function are now emerging.

Eye dryness

Dry eyes can occur from conditions such as:[2]

The inability of tears to drain into the nose can occur with:


  1. "Ophthalmologist and eponyms".
  2. Ervin AM, Wojciechowski R, Schein O (2010). "Punctal occlusion for dry eye syndrome". Cochrane Database Syst Rev. 9 (9): CD006775. doi:10.1002/14651858.CD006775.pub2. PMC 3729223Freely accessible. PMID 20824852.

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