Tear Film Breakup and Structure Studied by Simultaneous Video Recording of Fluorescence and Tear Film Lipid Layer Images

被引:82
作者
King-Smith, P. Ewen [1 ]
Reuter, Kathleen S. [1 ]
Braun, Richard J. [2 ]
Nichols, Jason J. [3 ]
Nichols, Kelly K. [3 ]
机构
[1] Ohio State Univ, Coll Optometry, Columbus, OH 43210 USA
[2] Univ Delaware, Dept Math Sci, Newark, DE 19716 USA
[3] Univ Houston, Coll Optometry, Houston, TX USA
基金
美国国家科学基金会;
关键词
tear film lipid layer; fluorescein breakup; evaporation; hyperosmolarity; DRY EYE DISEASE; MEIBOMIAN GLAND SECRETIONS; WORKSHOP; 2007; EVAPORATION; SUBCOMMITTEE; PRECORNEAL; DYSFUNCTION; INSTRUMENT; OSMOLARITY; THICKNESS;
D O I
10.1167/iovs.13-11878
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
PURPOSE. The thinning of the precorneal tear film between blinks and tear film breakup can be logically analyzed into contributions from three components: evaporation, flow into the cornea, and tangential flow along the corneal surface. Whereas divergent tangential flow contributes to certain types of breakup, it has been argued that evaporation is the main cause of tear thinning and breakup. Because evaporation is controlled by the tear film lipid layer (TFLL) it should therefore be expected that patterns of breakup should match patterns in the TFLL, and this hypothesis is tested in this study. METHODS. An optical system is described for simultaneous video imaging of fluorescein tear film breakup and the TFLL. Recordings were made from 85 subjects, including both with healthy and dry eyes. After instillation of 5 mu L2% fluorescein, subjects were asked to blink 1 second after the start of the recording and try to maintain their eyes open for the recording length of 30 or 60 seconds. RESULTS. Areas of tear film thinning and breakup usually matched corresponding features in the TFLL. Whereas thinning and breakup were often matched to thin lipid, surprisingly, the corresponding lipid region was not always thinner than the surrounding lipid. Occasionally, a thin lipid region caused a corresponding region of greater fluorescence (thicker aqueous layer), due to convergent tangential flow. CONCLUSIONS. Areas of tear thinning and breakup can generally be matched to corresponding regions of the TFLL as would be expected if breakup is largely due to evaporation. Surprisingly, in some examples, the corresponding lipid area was not thinner and possibly thicker than the surrounding lipid. This indicates that the lipid was a poor barrier to evaporation, perhaps because of deficiency in composition and/or structure. For example, bacterial lipases may have broken down esters into component acids and alcohols, causing a defective TFLL structure with increased evaporation.
引用
收藏
页码:4900 / 4909
页数:10
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