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Review
. 2017 Jul;15(3):366-403.
doi: 10.1016/j.jtos.2017.03.006. Epub 2017 Jul 20.

TFOS DEWS II Tear Film Report

Mark D P Willcox  1 , Pablo Argüeso  2 , Georgi A Georgiev  3 , Juha M Holopainen  4 , Gordon W Laurie  5 , Tom J Millar  6 , Eric B Papas  7 , Jannick P Rolland  8 , Tannin A Schmidt  9 , Ulrike Stahl  10 , Tatiana Suarez  11 , Lakshman N Subbaraman  10 , Omür Ö Uçakhan  12 , Lyndon Jones  10
Affiliations
Review

TFOS DEWS II Tear Film Report

Mark D P Willcox et al. Ocul Surf. 2017 Jul.

Abstract

The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership.

Keywords: Dry eye disease; Evaporation; Lipidome; Mucin; Osmolarity; Proteome; Tear film; Tear film stability; Tears.

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Figures

Fig. 1
Fig. 1
Examples of tear ferning patterns for Rolando’s grade 1 (A), 2 (B), 3 (C), 4 (D). From Maragou et al., 1996. Clin Rheumatol. 15: 125–32 [177].
Fig. 2
Fig. 2
Tear film lipid layer interferometry grading patterns. From Yokoi et al., Correlation of tear lipid layer interference patterns with the diagnosis and severity of dry eye. Am J Ophthalmol. 1996; 122: 818–24 [35]. A = Grade 1 (gray uniform), B = Grade 2 (gray non-uniform), C = Grade 3 (few colors non-uniform), D = Grade 4 (many colors non-uniform), E = Grade 5 (partly exposed corneal surface).
Fig. 3
Fig. 3
The tear film structure showing the mucins and galectin of the glycocalyx, soluble mucins and proteins in the mucoaqueous layer and the surface lipid layer. Adapted from Craig et al., 2013 [54].
See this image and copyright information in PMC

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