====== Schirmer Test ======
  * Schirmer I test
    * Without Anesthetic
      * Measures the basal tear secretion plus the reflex tearing from the main lacrimal gland
      * Often used when suspecting [[sjogren_syndrome|Sjögren syndrome]] 
    * With Anesthetic
      * Measures the basal tear secretion
      * Use in children  
  * Schirmer II test
    * nasal mucosa is first irritated with a cotton-tipped applicator 

==== Schirmer I Test Procedure ====
  - Insert topic anesthetic drop (omit depending on tearing aspect being tested) 
  - Place a paper wick to draw up tears
    - Before placing the strip ensure there isn't reflex tearing present from the anesthetic 
    - Place the bent strip on the eyelid margin on the outer lower 1/3 so it doesn't touch the cornea 
  - Start a timer for 5 minutes
  - remove the strip and measure the length of the wetting from the bend in the paper 

=== Results ===
  * Normal
    *  ≥10 mm wetting of the paper
  * Possible Tear Deficiency 
    * 5-10 mm wetting
  * Tear deficiency
    * <5 mm wetting

==== References ====
  * Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, Gupta PK, Karpecki P, Lazreg S, Pult H, Sullivan BD, Tomlinson A, Tong L, Villani E, Yoon KC, Jones L, Craig JP. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017 Jul;15(3):539-574.
  * {{ ::diagnostic_tests_sicca_syndrome.pdf |van Bijsterveld 1969. Diagnostic Tests in the Sicca Syndrome}}