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

2. DRY EYE OCCURS IN 1. KERATO CONJUNCTIVITIS SICCA. 2. CHEMICAL INJURIES. 3. VITAMIN A DEFICIENCY. 4. POST – TRACHOMATOUS SCARRING. 5. CHRONIC BLEPHARITIS. 6. CONGENITAL DRY EYE. 7. STEVEN JOHNSONS SYNDROME.

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

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

5. SCHIRMERS TEST 2 RIGHT EYE - 10 MM IN 5 MINUTES LEFT EYE - 10 MM IN 5 MINUTES If the entire strip is wetted with in five minutes this also should be noted on the chart If the entire strip is wetted with in five minutes this also should be noted on the chart This is very useful for patient follow up. This is very useful for patient follow up.

6. Continue Continue Schirmers with anaesthesia procedure is done to rule out reflex tearing After explaining to the patient apply topical anaesthetic drops in both eyes. dry the sac gently with sterile cotton, perform the schirmers test as described in 2. After explaining to the patient apply topical anaesthetic drops in both eyes. dry the sac gently with sterile cotton, perform the schirmers test as described in 2.RESULT: Below 5mm of wetting after 5 minutes indicates basal hypo secreation as would be found in keratitis sicca. Below 5mm of wetting after 5 minutes indicates basal hypo secreation as would be found in keratitis sicca.

7. Measurement 10 mm to 15 mm is normal. Less than 10 mm very suggestive of dry eye. Less than 5mm in test 2 is abnormal

8. Treatment for dry eye – ARTIFICIAL TEAR DROPS – SILICON PLUGS – PUNCTUM CAUTERIZATION SILICON PLUGS SILICON PLUGS – TEMPERARY – PERMANENT