Schirmer's test I & II: Dry Eye Screening

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


  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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