ophthalmology rheumatology

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. Severity levels follow the DEWS 2007 grading (≤10, ≤5, ≤2 mm). Wetting of 5 mm or less in at least one eye scores 1 point in the 2016 ACR/EULAR primary Sjögren's classification criteria (4 or more points classify).

Score interpretation

Normal Aqueous Tear Production (> 10 mm) 0

→ If symptoms persist, consider evaporative dry eye (meibomian gland dysfunction): warm compresses, lid hygiene, omega-3.

Reduced Tear Production (6–10 mm) 1

→ Preservative-free artificial tears 4× daily; lid hygiene; review computer/contact lens hygiene; humidifier.

Moderate–Severe Aqueous Deficiency (3–5 mm) 2

5 mm or less in at least one eye meets the ACR/EULAR 2016 Schirmer item (1 point) — consider Sjögren's if there is dry mouth or systemic features.

→ Hourly preservative-free tears + nighttime ointment (Lacri-Lube). Adults: consider topical ciclosporin 0.1% (Ikervis) or short course topical steroid for inflammation. Children: use a children's formulary. Punctal plugs.

Severe Aqueous Deficiency (≤ 2 mm) 3

→ 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

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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