Dry eye disease (DED) is a common, multifactorial disorder of the ocular surface that can impair visual comfort, visual performance, and quality of life. It is associated with loss of tear-film homeostasis and may involve tear hyperosmolarity, inflammation, ocular-surface damage, and neurosensory abnormalities. Aging, prolonged digital-device use, environmental exposure, and systemic conditions can contribute to its development. Accurate assessment is essential because symptoms do not always correspond closely with clinical signs. The Schirmer test remains a widely used, inexpensive method for estimating aqueous tear production, particularly when aqueous-deficient dry eye is suspected. Schirmer Test: Procedure and Variations The Schirmer test measures the length of wetting on a standardized filter-paper strip placed in the lower conjunctival fornix, usually near the junction of the middle and lateral thirds of the lower eyelid. The patient generally closes the eyes gently for five minutes, after which the wetted length is recorded in millimeters. Schirmer I testing without topical anesthesia reflects a combination of basal and reflex tearing, including tearing stimulated by the strip itself. Testing after topical anesthesia aims to reduce reflex tearing and provide a closer estimate of basal secretion. Because the methods are not equivalent, the use of anesthesia should always be documented when reporting results. Interpretation and Diagnostic Limitations For Schirmer I testing without anesthesia, wetting of 5 mm or less in five minutes is commonly regarded as suggestive of markedly reduced aqueous tear production. Values of approximately 6–10 mm may raise concern but require interpretation alongside symptoms and other ocular-surface findings. Thresholds vary across clinical protocols, and a single measurement should not be considered definitive. Results can be influenced by room conditions, patient discomfort, reflex tearing, strip placement, medication use, and test-to-test variability. Furthermore, a normal Schirmer result does not exclude evaporative dry eye, which may arise from meibomian gland dysfunction despite relatively preserved tear production. Complementary Clinical Assessment A comprehensive dry eye evaluation combines symptom assessment with objective examination. Validated questionnaires, such as the Ocular Surface Disease Index (OSDI), help quantify the patient’s perceived burden. Tear break-up time provides information about tear-film stability, while corneal and conjunctival staining can reveal epithelial damage. Examination of the eyelid margins and meibomian glands is also important, as aqueous deficiency and increased evaporation frequently coexist. Interpreting these findings together supports a more accurate classification of dry eye and helps guide individualized management. Conclusion The Schirmer test is a practical, low-cost tool for assessing aqueous tear production and remains valuable in routine ophthalmic and optometric practice, especially in resource-limited settings. Its diagnostic usefulness is greatest when the testing method is standardized and results are interpreted in conjunction with symptoms, tear-film stability, ocular-surface staining, and eyelid assessment. Rather than serving as a stand-alone diagnostic test, Schirmer testing should be viewed as one component of a comprehensive evaluation of dry eye disease. University of Al-Mustaqbal – The First and Leading Private University