SCHIRMERS TESTSCHIRMERS TEST

PURPOSEPURPOSE..

•To measure the quantity of tear To measure the quantity of tear secretion secretion •Special filter paper is used for this test Special filter paper is used for this test (no 46 watt man) Alcon schirmers tear (no 46 watt man) Alcon schirmers tear test strips). This test is done for test strips). This test is done for evaluating the amount of tears evaluating the amount of tears produced by patient eye.produced by patient eye.

DRY EYE OCCURS INDRY EYE OCCURS IN

1.1. KERATO CONJUNCTIVITIS SICCA.KERATO CONJUNCTIVITIS SICCA.

2.2. CHEMICAL INJURIES.CHEMICAL INJURIES.

3.3. VITAMIN A DEFICIENCY.VITAMIN A DEFICIENCY.

4.4. POST – TRACHOMATOUS SCARRING.POST – TRACHOMATOUS SCARRING.

5.5. CHRONIC BLEPHARITIS.CHRONIC BLEPHARITIS.

6.6. CONGENITAL DRY EYE. CONGENITAL DRY EYE.

7.7. STEVEN JOHNSONS SYNDROME.STEVEN JOHNSONS SYNDROME.

SCHIRMERS TEST DONE IN SCHIRMERS TEST DONE IN TWO WAYSTWO WAYS

Schirmers without anaesthetic Schirmers without anaesthetic Schirmers with anaestheticSchirmers with anaesthetic1.first the patient should be informed that it 1.first the patient should be informed that it is a simple and painless test, performed to is a simple and painless test, performed to measure the amount of tears produced by measure the amount of tears produced by eyes and that they may feel a little irritation .eyes and that they may feel a little irritation .2. The patient is seated in the room. For his 2. The patient is seated in the room. For his comfort the room light and fan are to be comfort the room light and fan are to be switched off before starting this test. Any switched off before starting this test. Any excess moisture on the eye lid margin should excess moisture on the eye lid margin should be dried using cotton. Should not use drops be dried using cotton. Should not use drops for schimersfor schimers. .

SCHIRMERS TEST 1SCHIRMERS TEST 1

Ask the patient to look up and pull the lower lid Ask the patient to look up and pull the lower lid gently downward temporally, use sterile technique.gently downward temporally, use sterile technique.Get schirmers paper from the cover and bend end of Get schirmers paper from the cover and bend end of the sterile strip 5mm at 120the sterile strip 5mm at 120oo angle. It is kept in lateral angle. It is kept in lateral 1/3 of the lower lid margin and should not be 1/3 of the lower lid margin and should not be touching the cornea.touching the cornea.The patients should continue looking up during the The patients should continue looking up during the entire test some will prefer to keep their eyes closed entire test some will prefer to keep their eyes closed this is permissible .this is permissible .Squeezing the eye lid should be discouraged. After 5 Squeezing the eye lid should be discouraged. After 5 minutes remove the strip from the eye and measure minutes remove the strip from the eye and measure the length of the strip that is wet.the length of the strip that is wet.The bent part is not included in the final The bent part is not included in the final measurement. The result is usually noted as follows. measurement. The result is usually noted as follows.

SCHIRMERS TEST 2SCHIRMERS TEST 2

RIGHT EYE - 10 MM IN 5 MINUTESRIGHT EYE - 10 MM IN 5 MINUTES

LEFT EYE - 10 MM IN 5 MINUTES LEFT EYE - 10 MM IN 5 MINUTES

If the entire strip is wetted with in five If the entire strip is wetted with in five minutes this also should be noted on the minutes this also should be noted on the chart chart

This is very useful for patient follow up .This is very useful for patient follow up .

ContinueContinue

Schirmers with anaesthesia procedure is done Schirmers with anaesthesia procedure is done to rule out reflex tearing to rule out reflex tearing After explaining to the patient apply topical After explaining to the patient apply topical anaesthetic drops in both eyes. dry the sac anaesthetic drops in both eyes. dry the sac gently with sterile cotton, perform the gently with sterile cotton, perform the schirmers test as described in 2.schirmers test as described in 2.RESULT:RESULT:

Below 5mm of wetting after 5 minutes indicates Below 5mm of wetting after 5 minutes indicates basal hypo secreation as would be found in basal hypo secreation as would be found in keratitis sicca. keratitis sicca.

MeasurementMeasurement

10 mm to 15 mm is normal. 10 mm to 15 mm is normal.

Less than 10 mm very suggestive of Less than 10 mm very suggestive of dry eye.dry eye.

Less than 5mm in test 2 is abnormal Less than 5mm in test 2 is abnormal

Treatment for dry eye Treatment for dry eye – ARTIFICIAL TEAR DROPS ARTIFICIAL TEAR DROPS

– SILICON PLUGS SILICON PLUGS – PUNCTUM CAUTERIZATIONPUNCTUM CAUTERIZATION

SILICON PLUGS SILICON PLUGS – TEMPERARYTEMPERARY

– PERMANENTPERMANENT