ASSIGNMENT: SCHIMER TEST

BY

DIVINE CHINAEMEZU OKOLIE: LSC2007145

COURSE TITLE/CODE: GENERAL OPTOMETRY (OPT312)

COURSE LECTURER: DR BAZUAYE K.N.

DEPARTMENT OF OPTOMETRY

FACULTY OF LIFE SCIENCES,

UNIVERSITY OF BENIN,
BENIN CITY.
 SCHIRMER TEST
Definition/Introduction
The SCHIRMER test or SCHIRMER TEAR TEST (STT) is used to assess tear
production, especially in patients with suspected keratoconjunctivitis sicca, dry
eye, or tear overproduction. The test works by the principle of capillary action,
which allows the water in tears to travel along the length of a paper test strip in an
identical fashion as a horizontal capillary tube. The rate of travel along the test
strip is proportional to the rate of tear production.
ISSUES OF CONCERN
Some clinical studies have demonstrated that the STT does not reliably detect the
efficacy of drugs in patients undergoing treatment for dry eye. Some of the
investigations have included a comparison of the test with eyes open vs. eyes
closed eye position, measurement time, and the use of anesthesia.
CLINICAL SIGNIFICANCE
The SCHIRMER test is used in ophthalmic examination to measure tear
production for the diagnosis of conditions such as keratoconjunctivitis sicca and
dry eye, which can manifest in a number of symptoms such as foreign body or
gritty sensations, burning/stinging, tearing, photophobia, and/or intermittent sharp
pains in the eyes. Keratoconjunctivitis sicca refers to dry eye in general, as well as
inflammation of the conjunctiva and cornea. Dry eye is divided into decreased tear
production and increased tear evaporation subtypes, both of which result in an
insufficient fluid layer that normally covers the eye. It is the most prevalent ocular
condition in elderly patients. Risk factors for dry eye include refractive surgery,
age greater than or equal to 50 years, and female sex. In 2007 ,the definition of dry
eye was updated to designate it as a multifactorial disease involving the tears and
ocular surface and causes discomfort or visual disturbance, with potential damage
of the ocular surface. It is also accompanied by increased osmolarity of the tear
film and an inflammation of the ocular surface.
A positive SCHIRMER test alone does not definitively diagnose
keratoconjunctivitis sicca or dry eye; rather, the diagnosis is made by a
combination of subjective history and objective physical findings. There are
several different underlying mechanisms that manifest in symptoms of dry eye.
Treatment should be tailored to the specific mechanism underlying the patient’s
dry eye.
ADVANTAGES:
A. Determines to an extent the amount of precorneal tear available.
B. Underlying subjective case can be detected alongside carrying out the test.

DISADVANTAGES:
A. Low reproducibility and sensitivity.
B. Frequent discomfort.
C. Difficulty in performing the test in children.
D. Potential injury to the conjunctiva and cornea.
E. Uneven absorption.

CLINICAL ASPECT OF CARRYING OUT THE TEST

Below are the three stages of carrying out the SCHIRMER TEST, each with three
steps.
The hands are properly washed before commencement to ensure cleanliness during
the procedures.
STAGE ONE: ASSEMBLING OF INSTRUMENTS
STEP I: GATHER THE INSTRUMENTS
Test object:
 Solid objects Schirmer test strips,
 Liquid object sterile saline solution,
 Accessory object: a ruler, a small strip of blotting paper, and a sterile eye
speculum.
STEP II: SET UP OF INSTRUMENTS
The test strip is labelled as ”L and R” for the left and right eyes respectively.
Next, each strip is bent at 90° degree angle.
STEP III: STANDARDIZATION OF INSTRUMENTS:
Ensure the strips are new ones and are sterile before commencement of procedure.

STAGE TWO: BUILD UP OF PATIENT AND CLINICIAN

STEP I: SET UP OF PATIENT AND CLINICIAN
 Clinician should inform the patient on test about to be carried out and why
it’s necessary for the patient to do it.
 It should also be made known to the patient what he/she should and
shouldn’t do during the test to ensure a precise result.
 Patients are advised not to blink during the test.
STEP II: SELECT POSTURE OF PATIENT AND CLINICIAN
The patient should be positioned in an upright seated position and the clinician can
either be seated or standing. The trunk and head of the patient should also be in an
upright position while their hands should rest by their sides.
STEP III: STANDARDIZE SET-UP
 LATERALITY: Clinicians position should be relative to the patient in other
words,he should be at the side of the patient being tested.
  LEVEL OF THE EYE: The patient is instructed to look upward.
 LIGHTING: To carry out this procedure the illumination of the testing room
should be ambient. That is, it should be a comfortable level of brightness for
an indoor setting.

STAGE THREE: COMMENCE EXAMINATION PROCEDURES

STEP I: SELECT TEST OBJECT
The clinician should select test object (SCHIRMER test trip) and accessory
object(Eye speculum) ensuring both are sterile for procedure.
STEP II: PROCEED WITH THE EYE EXAMINATION PROCEDURE
1. Insert Speculum: The sterile eye speculum is placed between the eyelids to keep
the eye open.
2. Measure the Strip: Using a ruler,a line at 5mm point on the Schirmer test strip is
marked and results will be taken from this line.
3. Place the Strip: The SCHIRMER strip is carefully inserted into the lower
conjunctival sac of the patient’s eye such that it rests between the palpebral
conjunctiva of the eyelid and the bulbar conjunctiva of the eyes without
touching the cornea. Making sure the marked line is positioned at the outer
corner of the eye
4. The procedure is then repeated for the other eye Once both strips have been
introduced into the patients eyes, the patient is then asked to keep his or her
eyes closed gently(without squeezing).
5. Wait: The strip is allowed to sit in the eye for 5 minutes. During this time, the
patient should keep their eyes closed and avoid blinking excessively.

STEP III: STOP PROCEDURE AND RECORD FINDING.

Record Results: After 5 minutes, the patient is asked to open both eyes and look
upwards so that the strips are carefully removed and measurement from the wet
portion of the strip is taken. This measurement indicates the amount of tear
production in millimeters.
Recordings:
Right eye: 10mm in 5 minutes
Left eye:15mm in 5 minutes
A normal tear production rate is typically around 10-30mm of wetting in 5
minutes. If the measurement is significantly lower, it may indicate dry eye
syndrome or other eye conditions.
 Material used for carrying out procedures are carefully disposed and the
surrounding vicinity disinfected immediately.
The results and any necessary recommendations are shared with the patient at this
point. Treatment options are also shared with the patient in the case of an abnormal
tear production.
 REFERENCES:
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Schirmer strip
2. Stevens S. Schirmer’s test. Community Eye
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volume estimation using a modified Schirmer test: a randomized, multicenter,
double-blind trial comparing 3% diquafosol ophthalmic solution and artificial
tears in dry eye patients.
4. Serruya LG, Nogueira DC, Hida RY. Schirmer test performed with open and
closed eyes: variations in normal individuals. Arq Bras Oftalmol. 2009 Jan-
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Clinically Normal New Zealand White Rabbits by Using the Schirmer Tear Test
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