Skip to main content
Hashemi Eye Care - Neuroscience Institute and Research Center

Schirmer Test

A simple test measuring tear production. Learn what the Schirmer test tells us about dry eye and what to expect during the procedure.

6 min read

The Schirmer test is a simple, commonly used test that measures how much tears your eyes produce. It helps diagnose dry eye syndrome, particularly the type caused by insufficient tear production (aqueous deficient dry eye). The test involves placing a small paper strip under your lower eyelid and measuring how much it gets wet over five minutes.

Key Takeaways

  • Measures tear production (quantity of tears)
  • Simple, quick test—takes about 5 minutes
  • Helps diagnose aqueous-deficient dry eye
  • Low values suggest insufficient tear production
  • Often done with other dry eye tests for complete assessment
  • May be slightly uncomfortable but not painful

Why It's Done

The Schirmer test is performed to:

  • Diagnose dry eye syndrome
  • Differentiate aqueous-deficient dry eye from evaporative dry eye
  • Evaluate for Sjögren's syndrome (autoimmune dry eye and dry mouth)
  • Monitor dry eye treatment effectiveness
  • Pre-surgical assessment (e.g., before LASIK)

Types of Schirmer Testing

Schirmer I Test (Most Common)

  • Measures total tear secretion (basal + reflex)
  • Done without anesthetic drops
  • Reflects total tear production
  • Used for general dry eye screening

Schirmer I with Anesthetic

  • Numbing drops applied first
  • Measures basal tear secretion only
  • Eliminates reflex tearing from strip irritation
  • More specific for true aqueous deficiency

Schirmer II Test

  • Nasal stimulation used to provoke reflex tearing
  • Evaluates lacrimal gland function
  • Less commonly performed

The Procedure

Before the Test

  • Remove contact lenses
  • Don't use eye drops for several hours before (affects results)
  • No special preparation needed

During the Test

What happens:

  1. You'll sit comfortably with eyes looking forward
  2. Small filter paper strip (5mm wide) is hooked over lower eyelid
  3. Strip is placed near the outer corner of eye
  4. Eyes closed gently (or eyes open—practices vary)
  5. Wait 5 minutes (timer used)
  6. Strip is removed and measurement read

You may feel a mild foreign body sensation but it shouldn't be painful.

After the Test

  • Resume normal activities immediately
  • May have slight irritation briefly
  • Can put contacts back in after any irritation resolves

Understanding Results

How It's Measured

The strip has millimeter markings. The wetting length from the notch is measured after 5 minutes.

Normal Values

Result Interpretation
> 15 mm Normal
10-15 mm Borderline/mild deficiency
5-10 mm Moderate aqueous deficiency
< 5 mm Severe aqueous deficiency

Important Notes

  • Values are somewhat variable
  • Results can be affected by environment, time of day, recent drops
  • A single low result should be interpreted in context
  • Repeated testing may be helpful

What Low Results Mean

Aqueous-Deficient Dry Eye

Low Schirmer values indicate your lacrimal glands aren't producing enough watery tears. Causes include:

  • Age-related tear gland changes
  • Sjögren's syndrome — autoimmune attack on tear and saliva glands
  • Other autoimmune conditions
  • Post-radiation changes
  • Diabetes
  • Some medications
  • Previous eye surgery affecting tear glands

Further Evaluation

If Schirmer is abnormal, your doctor may:

Schirmer Test vs. Other Dry Eye Tests

Test What It Measures
Schirmer Tear quantity (production)
TBUT Tear stability
Osmolarity Tear concentration
MMP-9 Inflammation
Meibography Meibomian gland structure

A complete dry eye workup often includes multiple tests.

Limitations

False Negatives

  • Reflex tearing may mask aqueous deficiency
  • Environmental humidity affects results
  • Some patients produce tears for the test but not baseline

False Positives

  • Anxiety or discomfort may suppress tearing
  • Recent eye drops can affect results
  • Some medications affect tear production

What Schirmer Doesn't Tell You

  • Tear quality (oil layer, stability)
  • Meibomian gland function
  • Ocular surface damage
  • Cause of dry eye symptoms

Frequently Asked Questions

Is the Schirmer test uncomfortable?

You'll feel the paper strip in your eye, which can cause mild foreign body sensation or slight watering. Most people tolerate it well. It's not painful.

How accurate is the Schirmer test?

The Schirmer test is useful but has variability. Results can differ between tests and are affected by many factors. It's best interpreted alongside other findings and symptoms.

My Schirmer test was normal but my eyes feel dry—why?

You may have evaporative dry eye from meibomian gland dysfunction rather than aqueous deficiency. In this case, tear production is normal but tears evaporate too quickly. Additional tests can identify this.

How often should I have this test?

Frequency depends on your condition. Initial diagnosis may involve baseline testing. Follow-up testing may be done to monitor treatment response, especially for conditions like Sjögren's syndrome.

Does the Schirmer test hurt?

Generally no. You'll feel the paper strip, which is unusual but shouldn't be painful. Some people find the sensation slightly uncomfortable, but it's brief.

What if I can't keep my eyes closed?

Some protocols allow eyes to remain open and look slightly downward. Your doctor can adapt the technique if needed.

References

Was this article helpful?