Indication: Evaluation of dry eye (Measures aqueous tear production)

1. Schirmer 1 (without anesthetic): measures baseline and reflex secretion
  • function of main lacrimal gland, whose secretory activity is stimulated by the irritating nature of filter paper
2. Schirmer 2 (without anesthetic): measures baseline secretion
  • function of accesory lacrimal glands (the basic secretors)
Materials required: 5 X 35 mm of Schirmer's strip or Whatman filter paper no. 41

  1. The eye is gently dried of excess tears
  2. The schirmer strip is folded 5 mm from one end and kept in the lower fornix at the junction of lateral 1/3 and medial 2/3 (do not touch cornea or lashes)
  3. The patient is asked to close the eyes.
  4. Tears in the conjunctival sac will cause progressive wetting of the paper strip.
  5. After 5 minutes, the filter paper is removed and the distance between the leading edge of wetness and the initial fold is measured, using a millimeter ruler.
Normal: >15 mm
Mild-moderate Keratoconjunctivitis sicca (KCS): 5-10 mm
Severe KCS: <5 mm
<10 mm is considered abnormal in Schirmer 1 and < 5 mm in Schirmer 2
Causes of KCS:
  1. Idiopathic
  2. Congenial alacimia
  3. Xerophthalmia
  4. Lacrimal gland ablation
  5. Sensory denervation
  6. Collagen vascular disease: Sjogren syndrome, SLE, RA

Schirmer's test I & II: Dry Eye Screening

  • Uploaded by: Dr. Sujit
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    1. schirmer II is with anesthetic! not without

    2. Uncorrect!Schirmer test II is with anesthetic. Video very good

    3. The website is correct, the comments are wrong. From OphthoQuestions: Schirmer tests are without anesthetic. In Schirmer II the nasal mucosa is stimulated. <15mm is abnormal in Schirmer II. <5mm is abnormal in Schirmer I and 5-10mm is ambiguous. Schirmer III is after DCR. The Basic secretion test is WITHOUT anesthetic.

    4. cnk is correct, according to BCSC. Basic secretion is with anesthetic and normal is >10. Schirmer 1 tests basal secretion without anesthetic and normal is > 10. Schirmer 2 tests reflex secretion and is without anesthetic with nasal stimulation and normal is >15.

    5. Schirmer test 1 : with(basal) and without anesthetic(basal and reflex) + shirmer strip
      Shirmer test 2:irritating nasal mucosa (reflex)



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