Measuring Tear Secretion in Eyes (Schirmer`s Test)

6
Measuring Tear Secretion in Eyes
(Schirmer's Test)
Clinical
Schirmer’s Test is used to measure the
quantity of tear secretion especially for those
who suffer from dry eye syndrome. Special
filter paper (Whatmann No: 41) is used for
this test.
Schirmer's Test is done in two ways.
Dry Eye Syndrome
Procedure
Dry eye syndrome is caused by a chronic
lack of sufficient lubrication and moisture
on the surface of the eye. Persistent dryness,
scratchiness, red eyes, burning sensation,
foreign body sensation etc are common
symptoms of dry eye. Dry eye occurs
sometimes congenitally or due to Vitamin
A deficiency, chronic blepharitis, chemical
injuries, trachomatous scarring, Steven
Johnson’s syndrome and so on.
Switch off the fans. Patient is seated in chair
in a dim light room. Do not use any eye
drops, remove excess moisture from patients
eye lids, fold sterile Schirmer’s paper at the
mark, ask the patients to look-up and pull
I. Schirmer's without anaesthetic
II. Schirmer's with anaesthetic
Schirmer's Test -I
Required Materials:
•
•
•
•
•
•
Schirmer filter paper strip
Sterile wiper jar
Sterile forceps
Hand Towel
Soap
Timer
the lower lid gently down-ward temporally.
Use sterile technique to get Schirmer's paper
from the cover and bend the end of the
sterile strip at 5mm mark. It is kept in lateral
1/3 of the lower lid margin and should not
be touching the cornea. The patient should
continue looking up during the entire test.
Some will prefer to keep their eyes open and
normal blinking is permissible. Note the time.
Squeezing the eye lid should be discouraged.
After 5 minutes, remove the strip from the
Secretion - production; Permissible - allowed
A R A V I N D
E Y E
C A R E
S Y S T E M
7
eye and measure the length of the moistened
area using the millimeter scale on the strip.
If the strip becomes wet completely before
5 minutes it may be removed prematurely.
The bent part is not included in the final
measurement. The result is usually noted on
the chart as follows.
Inference
Right eye - 20 mm in 5 minutes
Left eye - 26 mm in 5 minutes
If the entire strip is wet within five
minutes, this also should be noted on the
chart. This is very useful for follow-up.
Schirmer's Test - II
Schirmer's with Anaesthesia : (Done to rule out
reflex tearing)
Reflex tearing indicates basal secretion.
After explaining to the patient, apply topical
anaesthetic drops in both eyes, dry the culde-sac gently with sterile cotton, and perform
the Schirmer's test II in the same way as
Schirmer’s test 1.
Below 5mm of wetting after five minutes,
indicates basal hypo secretion as would be
found in keratitis sicca.
Normal Measurements
S I More than 15 mm in all age groups (15 - 30
mm) - Normal
Less than 10 mm is suggestive of
moderate dry eye
Less than 5 mm is diagnostic of severe dry
eye.
S IILess than 5 mm is diagnostic of keratitis
sicca.
Treatment
1. Artificial tear drops
2. Silicon plugs
3. Punctum cauterization
- Ms. A.S. Shanmuga Sundari,
OPD – Tutor, Aravind - Tirunelveli
Keratitis sicca - Dryness of the cornea; Cauterization - Burning the part of the body
Compassion Apr - June, 2015