Clinical significance and role of the method
In clinical practice, Schirmer's test serves as a key instrumental test for the objective confirmation of lacrimal apparatus disorders.
The study is included in the list of mandatory diagnostic procedures for patients with the following conditions:
- Systemic lupus erythematosus (SLE) — when secondary Sjogren's syndrome is clinically suspected.
- Primary Sjogren's syndrome — as part of a specialized ophthalmological examination block.
- Inflammatory conditions of the cornea (keratitis) — to determine the etiology and evaluate the secretory function of the eye.
The test has a grade of recommendation C and a level of evidence 5.
Mandatory ophthalmological panel
When examining patients with systemic autoimmune diseases, Schirmer's test alone is insufficient. According to guidelines, an ophthalmological examination includes three mandatory complementary methods:
- Schirmer's test (determination of basal and reflex tear production).
- Norn's test (assessment of tear film stability).
- Corneal staining with vital dyes (use of specialized ophthalmological diagnostic drugs of group S01JA).
Application in the differential diagnosis of keratitis
Evaluation of the functional status of the lacrimal glands plays an important role in the differential diagnosis of corneal inflammation. When keratitis is suspected, the clinician considers a set of data:
- Lacrimal apparatus function: along with Schirmer's test, diagnostic tests with fluorescein and rose bengal are performed.
- Corneal syndrome: the severity of symptoms is markedly reduced in neurogenic keratitis, and in a resolved (chronic) process, the syndrome completely subsides.
- Corneal sensitivity and vascularization: assessment of the depth and type of vessel ingrowth.
- Character of the infiltrate: shape, color, affected area, and depth.
- Concomitant foci of infection: condition of the oral cavity, paranasal sinuses, and chest organs.
Role of the test in the management algorithm for systemic pathologies
Exocrine gland involvement requires an interdisciplinary approach. Diagnostics is not limited to an ophthalmological examination:
| Specialist profile | Mandatory studies |
|---|---|
| Ophthalmologist | Schirmer's test, Norn's test, corneal staining (S01JA) |
| Dentist / Maxillofacial surgeon | Sialometry, minor salivary gland biopsy |
| Laboratory diagnostics | Detection of antibodies to Ro/SS-A, La/SS-B, determination of ANA Hep-2 |
The ophthalmologist's triad in Sjogren's syndrome — "S-N-C": Schirmer (tear production), Norn (film stability), Colorant (vital corneal test).
Class and exam questions
What level of evidence is assigned to Schirmer's test in SLE?
The study has a grade of recommendation C and a level of evidence 5.
What other methods are included in the mandatory ophthalmological examination along with Schirmer's test?
The mandatory standardized protocol includes Norn's test and corneal surface staining with vital dyes (group S01JA).
What tests is Schirmer's test compared with in the diagnosis of keratitis?
For a comprehensive assessment of the lacrimal apparatus in keratitis, Schirmer's test is combined with rose bengal and fluorescein tests.
What else to study on this topic
- Herpetic keratitis (herpes corneae simplex): epidemiology and infection phases
- Serological markers of rheumatoid arthritis (anti-CCP, IgM RF, ANA Hep-2)
- Laboratory markers of inflammation: dynamics of ESR and CRP
- Criteria for synovial fluid analysis in monoarthritis
- Minor salivary gland biopsy and sialometry in the diagnosis of dry syndrome
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