A cotton applicator is inserted up the patients nostril and the nasal mucosa is gently irritated for 15 seconds. Measurements of less than 15mm's in 2 minutes is diagnostic of a reflex secretion problem. The Schirmer test should not be used alone as a diagnostic test, but rather in conjunction with tear break up time, slit lamp evaluation of the tear prism and corneal staining. It is best if all lights are turned off to maximize any visually apparent defects of the iris, crystalline lens, and ciliary body. TID appear just as they do when using a slit lamp.
Cataracts appear as dark opacities within the retroillumination of the pupil.
Ciliary masses appear as dark shadowed areas at or near the limbus. If the patient's chief complaint is headaches the sinuses must always be transilluminated using a transilluminator. If the patient reports they wake up with this same type of headache you usually can rule out visually related eye strain. Since the sinuses do not drain well during sleep they are usually the causing factor. Sinusitis is one of the leading causes of headache complaints.