Schirmer tear test

Suggested procedure for the standardized schirmer I tear test

To relieve apprehension the patient should be informed that a simple and painless.
Though slightly irritating, test will be performed to measurethye amounts of tears
produced by our eyes. The patient is seated in the examining chair with the room
lights dimmed and the patients head against a headrest for comfort. The
standardized test (schirmer I) should be performed before instillation of topical
medication or manipulation of the eyelids. Any excess moisture on the eyelid
margin should be dried using a sterile cotton-tip applicator. Topical anesthesia is not
used to perform the schrimer I test. Care should be exercised so that the strips are
placed at the junction of the middle and temporal one-third of the eyelid margin and
do not touch the cornea which can produce increased reflex lacrimation and pain.
Bend the round wick end of the test strips at the notch approximately 120 before
opening the sterile paper pouch. The strips can be visualized, if necessary, by
holding the paper pouch against light. Peel back the pouch and remove the strips,
the non-wick ends will be adjacent to the pouch opening to prevent contamination
of the wick ends by handling.
Technique of the test:
Ask the patient to look up and draw the lower lid gently downward and the
temporally. Hook the rounded bent end of the sterile strip over the junction or the
temporal and medial one-third of the lower eyelid margin. Again make sure this has
been thoroughly dried with a cotton-tip applicator. Next, note the time and keep the
room illumination dim for comfort. Patient should continue looking up thoroughout
test to strip does not touch cornea. The patient may continue normal blinking
although some will prefer to keep their eyes closed during the test, which is
permissible. Squeezing the eyelid should be discouraged. After five minutes have
elapsed, remove the strips and measure the length of the moistened area from the
notch using the millimeter scale on the edge of the envelope. The bent part of the
strip with the rounded end serves as a wick and is not included in the final
measurement. The result is usually noted on the patients chart as follows:
schrimer(right:10mm in 5minutes- left:8mm in 5 minutes_. If the entire strip is
wetted within 5 minutes this should be noted on the chart. Placing the results of the
schrimer test in the same place on each chart using a colored pencil will facilitate
finding results on follow-up visits.

Evaluation of result
A measurement of 10-15mm or more (length of moistened are from the bend) in
each eye is regarded as standard for normal tear production. The schrimer test
measures reflex and basic tear secretion. Wetting of the entire strip, especially if

grossly asymmetric, should prompt further investigation for possible tear drainage
dysfunction. Above age 40 the normal values may vary between 10 and 5mm. a
value less than 5mm is very suggestive of a true dry eye state. A carefully
performed schrimer test will often reveal a reduced secretion of tears which may be
responsible for a number of ocular complaits including gritty or foreign body
sensation, burning, dryness,etc. the test is performed frequently to diagnose
patients with the dry eye syndrome, to evaluate lacrimal gland function in contact
lens wearers, to check tear production prior to eyelid surgery and prior to corneal
transplantation and cataract surgery. A number of patients with dry eye syndrome
may demonstrate the pseudoephiforia phenomenon. In these patients the reflex
lacrimation may demonstrate an adequate tear production (schrimer) in respons to
the constant reflex lacrimation. The basic secretion test should be performed
using topical proparacaine anesthesia to distinguish those patients with
pseudoephiforia. If the moistened portion of the strips can not be easly visualized,
hold the strips against light. Always place the notch of the strips towards the lateral
canthus to aid in reproducibility of measurements. Several measurements should be
made on repeated viwits and averaged to obtain an accurate result.

Contact lenses:
The sterile strip are widely used to determine the adequacy of lacrimal function in
evaluating patients for contact lenses

Shrimer tes 2
Lester jones has devised a modification of the schrimer 1 test to asses the
adequacy of reflex lacrimation. The strip are insertedin the usual manner. The nasal
mucosa is then gently irritated with a small cotton tip applicator to provoke reflex
lacrimation. If after 5 minutes the strip shows less than 10mm of wetting, the
patients is unable to produce reflex lacrimation and has demonstrated reflex
lacrimation failure if >/+ 10mm of wetting are shown, the patients has
demonstrated adequate reflex lacrimation to a suitable irritative stimulus
Schirmer tes air mata
standar prosedur tes schirmer
Untuk mengurangi ketakutan pasien harus diberitahu bahwa pemeriksaannya
sederhana dan tidak terasa sakit. tes akan dilakukan untuk mengetahui jumlah air
mata yang diproduksi oleh mata kita . Pasien duduk di kursi dengan kepala
menyandar di kursi agar terasa lebih nyaman, pemeriksaan dilakukan dikamar
redup. Tes standar (Schirmer I) harus dilakukan sebelum diberikan obat topikal.
Pada bagian kelopak mata yang lembab, dikeringkan dengan kapas aplikator yang

steril. Tidak diperlukan anestesi topical dalam pemeriksaan ini. Kertas strip
diletakan pada 1/3 arah samping dari kelopak mata.diantara kelopak mata bagian
dalam dan tidak menyentuh kornea yang dapat menyebabkan peningkatan
lakrimasi dan nyeri. Lipat ujung kertas strip sekitar 120derajat sebelum membuka
pembungkus kertas strip.
Teknik tes:
Minta pasien untuk melihat ke atas dan menarik kelopak mata bawah dengan
lembut ke bawah dan kea rah temporal. Letakan kertas strip pada 1/3 arah
samping dari kelopak mata.. pastikan kelopak mata telah benar-benar kering
dengan kapas aplikator. Selanjutnya, perhatikan waktu dan menjaga pencahayaan
ruangan untuk kenyamanan. Pasien harus terus diawasi agar kertas strip tidak
menyentuh kornea. Pasien dapat terus berkedip yang normal meskipun pada
beberapa pasien akan lebih memilih untuk menjaga mata mereka ditutup selama
tes. Pasien harus dapat bertahan untuk tidak menggosok kelopak mata dengan
menggunakan tangan sampai pemeriksaan selesai 5 menit kemudian .Setelah lima
menit telah berlalu, keluarkan kertas strip, amati dan mengukur panjang daerah
yang basah menggunakan skala milimeter. Melipat bagian dari strip dengan ujung
bulat berfungsi sebagai sumbu dan tidak termasuk dalam pengukuran akhir.
Hasilnya biasanya dicatat pada tabel pasien sebagai berikut: schrimer (kanan:
10mm setelah 5 menit -kiri:8mm setelah 5 menit. Jika seluruh strip basah dalam
waktu 5 menit, maka harus dicatat dalam grafik menggunakan pensil warna untuk
memudahkan menemukan hasil pada tindakan di kunjungan lanjut.