Schirmer’s Test for Dry Eye
What is Dry Eye?
Dry eye occurs when your eyes lack enough moisture or when your tears do not work properly to keep your eyes comfortable. Understanding the symptoms, causes, and risks helps you recognize the condition early and seek care to prevent complications that can affect your vision and daily quality of life.
If you have dry eye, you might feel like there is sand or grit in your eyes or experience a burning and stinging sensation that gets worse as the day goes on. Your eyes could look red, feel tired, or make it hard to wear contact lenses comfortably. Some people notice blurry vision that gets better when they blink, watery eyes that seem to tear excessively as the eye tries to compensate, and symptoms that often worsen in dry, windy, or air-conditioned environments. Many patients find that reading, using computers, or driving at night becomes more challenging when dry eye is present.
Dry eye can come from many sources, including the natural aging process that reduces tear production over time. Certain medications like antihistamines, decongestants, antidepressants, and blood pressure drugs can decrease tear production. Medical conditions such as rheumatoid arthritis, diabetes, thyroid problems, and lupus are known to increase dry eye risk. The most common cause is meibomian gland dysfunction, which reduces the oily layer in tears and makes them evaporate too quickly. Environmental factors like extensive screen time that reduces your blink rate, low humidity, smoke exposure, and wind also play a significant role in developing dry eye symptoms.
Women are more likely to develop dry eye than men, especially after menopause due to hormonal changes that affect tear production. People over 50 face higher risks as tear production naturally decreases with age. Those who spend long hours staring at computer screens or digital devices tend to blink less frequently, which allows tears to evaporate faster. Individuals with autoimmune diseases like Sjögren's syndrome or rheumatoid arthritis have an increased chance of developing severe dry eye. Wearing contact lenses for extended periods, having certain eyelid problems like blepharitis, living in dry or windy climates, and previous eye surgery such as LASIK can all increase your chances of experiencing dry eye.
Dry eye broadly falls into two main categories, and understanding which type you have helps guide treatment. Aqueous-deficient dry eye occurs when your lacrimal glands do not produce enough of the watery component of tears, often seen in conditions like Sjögren's syndrome. Evaporative dry eye is the more common type and is caused by excessive tear evaporation, often linked to problems with the meibomian glands in your eyelids that produce the protective oil layer. Many people actually have a mixed type of dry eye with components of both inadequate tear production and excessive evaporation.
Without proper treatment, dry eye can lead to chronic discomfort and persistent inflammation that affects your daily activities and productivity. The condition increases your risk of eye infections because tears help protect against bacteria and other pathogens. In severe cases, untreated dry eye can cause damage to the corneal surface, leading to abrasions, ulcers, scarring, or even impaired vision. These complications highlight the importance of timely evaluation and management through comprehensive testing like Schirmer's test.
What is Schirmer's Test?
Schirmer's test is a quick, in-office procedure that checks tear production by placing a small paper strip under your lower eyelid for several minutes. It helps our ophthalmologists at ReFocus Eye Health Cheshire determine if low tear volume is causing your dry eye symptoms or if other factors are at play.
The test uses a thin strip of special filter paper that measures 5 millimeters wide by 30 millimeters long, placed at the edge of your lower eyelid for exactly five minutes. Numbing drops are sometimes applied before the test to ensure your comfort and to measure only your baseline tear production without triggering reflex tearing. The strip gradually absorbs your tears, and the doctor measures how much of the paper becomes wet. A reading of less than 5 millimeters often indicates severe dry eye, while 5 to 10 millimeters may suggest mild to moderate dry eye. More than 10 millimeters is usually considered normal, though some experts use 15 millimeters as the threshold for completely normal tear production.
You will sit comfortably in the exam chair while your eye doctor gently places the thin paper strips along the inner corner of your lower eyelids. You might feel a slight tickle or awareness of the paper, but the test causes no pain and takes just a few minutes per eye. You should keep your eyes gently closed or blink naturally during the test to avoid interfering with the results, and your doctor will let you know when the five minutes are complete. After removal, the doctor measures the wet portion of each strip and discusses what the results mean for your eye health.
Schirmer's test is most reliable for detecting significantly reduced tear production, especially in conditions like Sjögren's syndrome where tear volume is markedly low. However, the test may not catch milder cases or identify evaporative dry eye where tear quality rather than quantity is the problem. Results can vary based on factors like room temperature, humidity, time of day, and even emotional state, which is why the test is often combined with other exams. These additional evaluations may include tear break-up time measurements, meibomian gland evaluation using specialized imaging, and assessment of tear osmolarity for a complete diagnosis. Your eye doctor may repeat the test on different occasions if results are borderline or inconsistent with your symptoms.
There are two main types of Schirmer's test, each providing different information about your tear production. Schirmer I is done without anesthesia to assess both your baseline tear production and reflex tearing that occurs in response to irritation. Schirmer II uses a topical anesthetic to numb the eye and measures only the basal, or resting, tear secretion without the reflex component. Your doctor will select the appropriate version based on your symptoms and what information is needed to understand your specific dry eye pattern.
The test is generally very safe with minimal risk of any complications. Some patients may experience brief, mild irritation from the paper strips or a rare allergic response to the filter paper or numbing eye drops. Your eye doctor at ReFocus Eye Health Cheshire will take extra precautions if you have sensitive eyes, known allergies, or other ocular conditions. The test does not damage your eyes in any way and has been used safely for decades as a standard diagnostic tool in ophthalmology.
Why Get Schirmer's Test?
This test is a key step for confirming a dry eye diagnosis and guiding an effective, personalized treatment plan, especially if symptoms persist despite initial home care measures. It provides clear, objective data on tear production that complements your symptoms and helps rule out other conditions.
Anyone with ongoing eye discomfort, such as burning, excessive watering, grittiness, or sensitivity to light, should consider this test to identify the underlying cause. It is especially helpful for those with autoimmune conditions like Sjögren's syndrome, lupus, or rheumatoid arthritis, which are known to affect tear production. Patients who have had eye surgeries such as LASIK, cataract surgery, or cosmetic eyelid procedures may develop dry eye and benefit from testing. If over-the-counter artificial tears are not providing sufficient relief or if you are unsure whether your symptoms indicate dry eye or another condition, the test can help pinpoint the problem and direct treatment.
Spotting dry eye early through testing helps prevent worsening symptoms and potential damage to the delicate surface of your eye. Early diagnosis allows for personalized treatments that can be adjusted over time to improve your comfort and quality of life. Many patients feel significant relief and reassurance knowing their condition is manageable with proper care and not something more serious like an infection or other eye disease. Early intervention can prevent the progression to severe dry eye that may require more intensive treatment or procedures.
If your symptoms are very mild and respond well to simple changes like using a humidifier, taking frequent screen breaks, or staying well hydrated, you might not need formal testing right away. Your eye care team will make a recommendation based on your full medical history, symptom severity, and comprehensive examination findings. Other diagnostic tests may be more appropriate if tear quality rather than tear quantity appears to be the main concern, such as when meibomian gland dysfunction is strongly suspected based on your clinical presentation.
Schirmer's test is one important component of a comprehensive dry eye evaluation that takes multiple factors into account. This evaluation may also include detailed symptom questionnaires to assess how dry eye impacts your life, high-resolution imaging of the tear film to measure its stability, careful examination of the eyelids and meibomian glands, assessment of tear quality and composition, and measurement of tear osmolarity. At ReFocus Eye Health Cheshire, our ophthalmologists combine these tests to create a complete picture of your dry eye condition, enabling a more precise diagnosis and targeted treatment plan tailored to your specific needs.
Preparing for Schirmer's Test
Getting ready for the test is easy and involves just a few simple steps to ensure accurate and reliable results. Proper preparation helps make the experience smooth, comfortable, and efficient during your visit.
Avoid using artificial tears, lubricating eye drops, or eye ointments for at least two hours before your scheduled test, as these products can temporarily increase moisture on the eye surface and affect the accuracy of your results. If you wear contact lenses, please remove them before coming to your appointment and bring your glasses instead, as contacts can interfere with tear distribution and test measurements. Be sure to tell your eye care professional about any medications you are taking, including over-the-counter drugs and supplements, as well as any allergies or medical conditions that might affect your eyes or tear production.
Wear comfortable clothing and plan to relax during your appointment, as the test itself is brief and requires you to sit still for just a few minutes. It is best to arrive with a clean face and remove any eye makeup before the test to avoid interference with the paper strips and to ensure the most accurate measurements possible. You can stay hydrated and maintain your normal eating schedule, as drinking water or eating before the test does not directly impact tear production results during the brief testing period.
Inform your doctor about any medications you are currently taking, especially those known to influence tear production. These include antihistamines used for allergies, certain antidepressants and anti-anxiety medications, some blood pressure drugs, hormone replacement therapy, and acne medications like isotretinoin. Your doctor may advise continuing your medications as normal or, in some cases, may note how they could be affecting your tear production when interpreting test results. Never stop prescribed medications without consulting your doctor first.
Avoid rubbing your eyes on the day of your appointment, as this can temporarily stimulate tear production and affect the accuracy of the test results. Try not to expose your eyes to irritants like smoke, strong wind, or harsh chemicals before testing. Also avoid applying creams, lotions, or makeup around your eyes on test day, as these can transfer to the test strips and interfere with measurements.
Treatment Options After the Test
If Schirmer's test confirms you have dry eye, various effective treatments can help restore moisture and comfort to your eyes. The options range from simple lifestyle modifications to advanced medical therapies and will be carefully tailored to your specific type of dry eye, symptom severity, and overall health needs.
Many people find significant relief with simple adjustments at home and work that support healthier tear production and reduce evaporation.
- Use a humidifier to add moisture to the air in your home or office, especially during winter months when indoor heating reduces humidity levels.
- Take frequent breaks from screens every 20 minutes using the 20-20-20 rule: look at something 20 feet away for 20 seconds to encourage complete blinking and rest your eyes.
- Apply warm compresses to your closed eyelids for 10 minutes daily to help unblock oil glands and improve the quality of your tear film.
- Protect your eyes from wind and dry air by wearing wraparound sunglasses when outdoors, especially on windy days or in low-humidity environments.
- Position computer screens slightly below eye level to reduce the exposed eye surface area and decrease tear evaporation.
- Stay well hydrated by drinking plenty of water throughout the day, which supports overall body fluid balance including tear production.
Artificial tears can provide quick moisture relief without a prescription and come in many formulations to match different dry eye needs. Preservative-free options are safest for frequent use, as preserved drops can cause irritation when used more than four times daily. Some artificial tears are thicker and last longer, while others are lighter for mild symptoms. Omega-3 fatty acid supplements from fish oil or flaxseed oil may help improve the quality of the oil layer in your tears and reduce inflammation, though you should speak with your doctor before starting any new supplements to ensure proper dosing and rule out potential interactions with other medications.
For more persistent cases of dry eye that do not respond adequately to over-the-counter treatments, prescription medications offer targeted relief. Prescription anti-inflammatory eye drops like cyclosporine (Restasis) or lifitegrast (Xiidra) can reduce inflammation on the eye surface and boost your natural tear production over time, though they typically take several weeks to show full benefits. Punctal plugs are tiny devices, either dissolvable or permanent, that your eye doctor inserts into the tear ducts to help keep tears on the eye surface longer by slowing drainage. Newer prescription options include a nasal spray called varenicline (Tyrvaya) that stimulates natural tear production by activating nerve pathways, and specialized drops for treating evaporative dry eye caused by meibomian gland dysfunction.
For severe, complex, or treatment-resistant cases of dry eye, advanced therapeutic options are available at specialized eye care centers. These may include intense pulsed light therapy, which uses controlled light energy to treat inflammation and improve meibomian gland function in cases of evaporative dry eye. Autologous serum eye drops, made from your own blood serum, contain natural growth factors and proteins that can help heal the eye surface in severe dry eye. Scleral lenses are large, custom-designed contact lenses that vault over the cornea and create a protective reservoir of fluid that continuously bathes and hydrates the eye surface throughout the day. Procedures like meibomian gland expression, thermal pulsation systems, and even minor eyelid surgery may be recommended depending on your specific condition.
Dry eye is often a chronic condition that requires consistent care and monitoring over time rather than a one-time fix. Regular follow-up appointments with our ophthalmologists at ReFocus Eye Health Cheshire allow us to monitor your symptoms, track your response to treatment, and adjust your therapy as needed to maintain comfortable, healthy eyes. These visits help identify any changes in your condition early and ensure that treatments remain effective as your needs evolve. With proper ongoing management, most patients achieve significant improvement in comfort and maintain clear vision for the long term.
Frequently Asked Questions About Schirmer's Test
Here are answers to some of the most common questions our patients in Cheshire and throughout the Greater New Haven-Milford Metropolitan Area ask about Schirmer's test and dry eye diagnosis.
No, the test is not painful at all. Most people feel only a mild sensation, similar to an eyelash or a piece of paper lightly touching the inside of the eyelid. Numbing drops are often used before the test to ensure you remain completely comfortable throughout the brief procedure. Some patients report feeling nothing at all during the test.
The results are available immediately after the five-minute test is complete. Your eye care professional will carefully measure the amount of wetting on each paper strip right there in the exam room and explain what the numbers mean for your eye health. You will walk away from your appointment knowing your tear production levels and next steps for treatment if needed.
Yes, you can usually drive yourself home without any problems. The test does not affect your vision long-term or impair your ability to operate a vehicle safely. If numbing drops are used, your vision might be very slightly blurry for just a few minutes, but this clears quickly. Most patients have no driving restrictions after the test.
If your results indicate insufficient tear production, your care team will recommend a personalized treatment plan designed specifically for your level of dry eye and individual circumstances. This may include starting with artificial tears and lifestyle modifications, moving to prescription drops if needed, or considering advanced therapies for more severe cases. Most patients experience noticeable improvement in their symptoms with consistent care and proper treatment.
This test primarily measures the quantity of the watery component of your tears, so it is most effective for detecting aqueous-deficient dry eye where tear volume is low. However, it cannot directly identify evaporative dry eye caused by issues like meibomian gland dysfunction or poor tear quality. That is why your eye doctor will typically use additional tests such as tear break-up time, meibomian gland imaging, or tear osmolarity measurements to determine which type of dry eye you have and provide the most effective treatment.
Yes, the test is completely safe and can be performed on children of all ages, including young children and even infants when medically necessary. Younger patients may be more aware of the paper strips and might find the sensation unusual, but pediatric eye doctors use gentle techniques and take extra time to keep the test comfortable and accurate. The test helps diagnose dry eye in children who may have difficulty describing their symptoms clearly.
The frequency of testing depends on your individual symptoms, diagnosis, and how well you respond to treatment. Some patients only need the test once for an initial diagnosis and then manage their dry eye successfully without repeat testing. Others with chronic or fluctuating symptoms may have the test repeated every six months or annually to track their progress and guide treatment adjustments. Your eye doctor will recommend a testing schedule based on your specific situation.
Yes, several alternative and complementary tests are available for evaluating dry eye. These include measuring tear break-up time to assess how quickly your tears evaporate, tear osmolarity testing that measures the salt concentration in your tears as an indicator of dry eye, meibomian gland imaging using infrared cameras to visualize gland structure, and using special fluorescein or lissamine green dyes to examine the health of your corneal and conjunctival surfaces. Your doctor will choose the best combination of tests for a complete and accurate assessment of your dry eye condition.
Yes, certain systemic medications can significantly affect tear production and lead to lower test results. Common culprits include antihistamines for allergies, many types of antidepressants, some medications for high blood pressure, decongestants, sleeping aids, and certain acne treatments. Always provide your doctor with a complete and current list of all medications you take, including over-the-counter drugs and supplements, so they can interpret your test results accurately and account for medication effects when planning your treatment.
Contact lenses must be removed before the test because they sit on the tear film and can interfere with normal tear distribution across the eye surface, leading to inaccurate results. The test can actually help determine if discomfort you experience while wearing contacts is related to underlying dry eye rather than lens fit or other factors. If dry eye is confirmed, treatment may allow you to wear contacts more comfortably, or your doctor may recommend switching to more breathable lens materials or reducing wearing time.
The test can reveal the severe reduction in tear production that is a hallmark symptom of Sjögren's syndrome, an autoimmune condition that attacks moisture-producing glands throughout the body. However, Schirmer's test alone cannot diagnose Sjögren's syndrome definitively. If your results show very low tear production, especially in combination with dry mouth and other symptoms, your eye doctor may recommend further evaluation with blood tests and possibly a referral to a rheumatologist who specializes in autoimmune diseases for comprehensive testing and diagnosis.
In most cases, yes, insurance will cover the cost of Schirmer's test. Because dry eye is a recognized medical condition that can impact vision and quality of life, most insurance plans, including Medicare, cover diagnostic testing like Schirmer's test when medically necessary. However, coverage details and copayments can vary depending on your specific insurance plan, so it is always best to confirm your benefits with your insurance provider before your appointment if you have concerns about costs.
Several environmental and individual factors can affect test accuracy and lead to variable results. Room humidity and temperature, the time of day when testing occurs, recent use of eye drops or medications, your emotional state or stress level, and even your blinking patterns during the test can all influence how much the paper strips become wet. External factors like bright lights, air conditioning, or heating vents near the exam area may also play a role. This is why your eye doctor uses standardized procedures and may repeat the test if results are borderline, unexpected, or inconsistent with your reported symptoms.
A wetting measurement between 5 and 10 millimeters typically falls into a borderline or mild dry eye category and may signal intermittent or early-stage dry eye disease. In these cases, your doctor will carefully correlate the test findings with your specific symptoms, other diagnostic test results, medical history, and risk factors to develop an appropriate management plan. Some patients with borderline results respond well to conservative treatments like artificial tears and lifestyle modifications, while others may need closer monitoring or prescription treatments if symptoms are significantly affecting their daily life and comfort.
Taking Care of Your Eyes
Understanding Schirmer's test and how it helps diagnose dry eye empowers you to take an active role in protecting your eye health and comfort. If you notice persistent symptoms like burning, grittiness, excessive tearing, or blurry vision, our ophthalmologists at ReFocus Eye Health Cheshire are here to provide expert evaluation and personalized care. With the right diagnosis and treatment approach, most people find meaningful relief and maintain comfortable, clear vision for many years to come.
This was my first time at this office of Refocus. It was a good experience. Dr. Oropesa did my exam after Jose did the prep exam. Both were very professional. I would recommend this office.
Nan Tussing
Everyone in the Cheshire office is so friendly and professional. Very pleasant experience being seen in this office.
Gerri Gigi
Everything went well and I was in and out in 45 minutes. Dr. Swan is very professional and I have confidence in him. I will definitely stay with this group.
Stephen Wieda
Dr. White was professional, thorough, knowledgeable and friendly. I have had several procedures done by Dr. White and had all good experiences. The many visits for follow-up and continuing care continue to make me feel I am in good hands.
Had an urgent problem. Dr Swan saw me immediately. Truly outstanding care.
Charlotte Boulding
Contact Us
Tuesday: Array
Wednesday: Array
Thursday: Array
Friday: Array
Saturday: Array
Sunday: Array