Schirmer test

""At the Clinica, we study individually the best treatment for our patients with dry eye syndrome and blepharitis. For this reason, we put at your disposal the best human and technological equipment".


What is the Schirmer's test?

The Schirmer test is a diagnostic test used to evaluate tear production and determine if there is an alteration in the quantity or quality of the tear film. This test is mainly performed to diagnose dry eye, a common pathology that affects many people, but it can also be useful in the diagnosis of other ocular diseases.

The proper functioning of the tear film is essential for maintaining the health and integrity of the eye, as it provides lubrication, nutrition and protection against infections and external agents.

Alterations in tear production can cause bothersome symptoms such as burning, itching, redness and even decreased vision. Therefore, the Schirmer test is a useful tool to identify problems in tear production and guide the appropriate treatment.

Imagen del icono de la consulta de Segunda Opinión. Clínica Universidad de Navarra

Do you need our help?
Contact with us

What is the Schirmer test for?

Tear production

Tears are produced by the lacrimal glands and the meibomian glands, which are located in the eyelids. The tear film is composed of three layers: an outer lipid layer, an intermediate aqueous layer and an inner mucinous layer. The aqueous layer is the most abundant and the one measured in the Schirmer test.

Function of the tear film

The tear film serves several functions on the surface of the eye, including:

  • Lubrication: reduces friction between the eyelid and cornea.
  • Nourishment: provides oxygen and nutrients to the cornea.
  • Protection: defends the eye against infections and external agents.
  • Maintenance of transparency: facilitates the formation of a clear and uniform optical surface.

Indications for Schirmer's test:

  • Suspected dry eye or dry eye syndrome.
  • Evaluation of lacrimal function in patients with autoimmune diseases, such as Sjögren's syndrome.
  • Monitoring of treatment efficacy in cases of dry eye.
  • Differential diagnosis of ocular diseases with symptoms similar to dry eye.

Complementarity in diagnosis:

Schirmer's test is a useful test to evaluate the amount of tears produced, but it does not provide information on the quality of the tear film or on the presence of ocular surface alterations.

Therefore, it is recommended to combine the Schirmer test with other diagnostic tests to obtain a more complete evaluation of the ocular status and to establish the appropriate diagnosis and treatment.

Do you suspect you have a dry eye problem?

It may be necessary to perform a Schirmer test

Types of Schirmer test

Schirmer I test

The Schirmer I test is the most commonly performed test and is divided into two variants:

  • Without anesthesia (basal): used to measure basal tear production, that is, the amount of tears produced at rest.
  • With anesthesia (reflex): it is used to measure reflex tear production, which is the amount of tears generated in response to an external stimulus.

Schirmer II test

The Schirmer II test, also called Jones test or Schirmer test with nasal stimulation, evaluates tear production by stimulation of the trigeminal nerve through contact with the nasal mucosa.

This test is performed in specific cases and is less frequent than the Schirmer I test.

How is the Schirmer test performed?

Before performing the Schirmer test, the patient should be in a quiet, draft-free environment.

In addition, any contact lenses should be removed and it is recommended to discontinue the use of artificial tears or topical ocular medications at least 2 hours before the test.

  1. The patient is placed in a sitting position with the head upright.
  2. A strip of Schirmer's filter paper is folded at a 90-degree angle, approximately 5 mm from one end.
  3. For Schirmer's Test I without anesthesia, the patient is asked to close the eyes gently and the folded end of the strip is placed on the outer third of the lower eyelid, between the conjunctiva and the cornea.
  4. For Schirmer's Test I with anesthesia, a topical anesthetic is applied to the eye before the strip is placed.
  5. For Schirmer's Test II, a cotton swab is inserted into the patient's nostril to stimulate tear production before the paper strip is placed on the lower eyelid.
  6. The patient is asked to keep his or her eyes closed during the test, which usually lasts 5 minutes.
  7. At the end of the set time, the paper strip is removed and the length of the moistened area is measured.

Schirmer's test results are interpreted according to the amount of tears produced in 5 minutes:

  • Schirmer's Test I without anesthesia: normal if greater than 10 mm, indicative of dry eye if less than 10 mm.
  • Schirmer I test with anesthesia: normal if greater than 5 mm, indicative of dry eye if less than 5 mm.
  • Schirmer's test II: normal if greater than 15 mm, indicative of trigeminal nerve alterations if less than 15 mm.

The Schirmer test is contraindicated in patients with corneal wounds or ulcers, since the placement of the paper strip could aggravate the lesion.

In addition, caution should be exercised in patients with active eye infections or in those with hypersensitivity to the topical anesthetic used in the Schirmer I test with anesthesia.

Where do we do it?


The Department of Ophthalmology
of the Clínica Universidad de Navarra

Equipped with the latest technology, the Department of Ophthalmology has the necessary equipment, both technical and human, to offer comprehensive and specific assistance to each patient.

We are one of the few centers that have a microsurgery laboratory for the improvement of clinical practice.

Organized in specialized units

  • Cornea and eye surface
  • Retina
  • General Ophthalmology
  • Refraction defects
  • Oculoplastic
  • Pediatric ophthalmology
Imagen de la fachada de consultas de la sede en Pamplona de la Clínica Universidad de Navarra

Why at the Clinica?

  • More than 30 years of experience.
  • Experts in the diagnosis and treatment of ocular pathologies.
  • With the security and guarantee of a prestigious hospital.

Our team of professionals

Frequently Asked Questions

The Schirmer test may cause slight discomfort when the paper strip is placed on the lower eyelid, but it is generally not painful.

In the case of Schirmer's Test I with anesthesia, the discomfort is further reduced.

The Schirmer test usually lasts approximately 5 minutes, during which time the patient should keep his eyes closed.

Yes, it is important that the patient remove contact lenses and discontinue the use of artificial tears or topical ocular medications at least 2 hours before the test.

Schirmer's test can be supplemented with tests such as fluorescein staining, rose Bengal staining and tear osmolarity, which provide additional information on tear film quality and ocular surface status.

Schirmer's test II is performed in specific cases, such as when an alteration in the innervation of the trigeminal nerve, responsible for the reflex production of tears, is suspected.

This test is less frequent than the Schirmer I test and is reserved for situations in which the diagnosis is not clear with the usual tests.