Schirmer Test Severity for Dry Eye Disease
Quantifies aqueous tear production (Schirmer I — without anaesthesia). Strip placed at junction of middle and lateral 1/3 of lower lid, eyes closed for 5 minutes. Wetting <5 mm/5 min is a major criterion in 2016 ACR/EULAR Sjögren's classification.
Score interpretation
→ If symptoms persist, consider evaporative dry eye (meibomian gland dysfunction): warm compresses, lid hygiene, omega-3.
→ Preservative-free artificial tears 4× daily; lid hygiene; review computer/contact lens hygiene; humidifier.
→ Hourly preservative-free tears + nighttime ointment (Lacri-Lube). Consider topical ciclosporin 0.1% (Ikervis) or short course topical steroid for inflammation. Punctal plugs.
→ Screen for Sjögren's: anti-Ro/La, ANA, RF, salivary flow ± minor salivary gland biopsy. Refer to rheumatology if positive. Specialist ophthalmology — autologous serum eye drops, scleral lenses, surgical punctal occlusion. Treat keratitis aggressively to prevent scarring/perforation.
Interpretation bands for the Schirmer Test. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Sodium Hyaluronate 0.1% Eye Drops (Hylo-Forte) · Ocular lubricant (viscous eye drop — dry eye disease)
- Methotrexate (Dermatology — Psoriasis) · Disease-Modifying Antirheumatic / Immunosuppressant
- Tetracosactide · Synthetic ACTH (short Synacthen test)
- Pilocarpine · Muscarinic Agonist — Dry Mouth / Sjögren's
- Acetazolamide (Ménière's Disease) · Carbonic Anhydrase Inhibitor (Diuretic)
- Zinc acetate · Zinc salt (Wilson's disease)
- Acute Red Eye / Vision Loss Screen · RCOphth 2020; NICE CKS
- Idiopathic Intracranial Hypertension · ABN; consensus 2018
- Acute Red Eye Assessment · RCOphth / AAO
- Acute Angle Closure Glaucoma · RCOphth / EGS Guidelines
- Retinal Detachment · RCOphth Guidelines / EURETINA
- Diabetic Retinopathy — Screening and Management · NICE NG28 2016 / NHS DES Programme
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.