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      Estimación del grosor de la capa lipídica lagrimal mediante colores interferenciales en distintos tipos de ojo seco Translated title: Measure of the fatty layer thickness of precorneal tear film by interference colours in different types of dry eye

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          Abstract

          Objetivo: Estimar el grosor de la capa lipídica de la lágrima en distintas patologías que cursan con sequedad ocular, mediante el estudio de los colores interferenciales. Métodos: Hemos realizado un estudio prospectivo en 100 pacientes (50 varones y 50 mujeres) divididos en diez grupos. Nueve de estos grupos presentaban patología de ojo seco, mientras que el otro es un grupo control de pacientes sanos. Bajo exploración en lámpara de hendidura se realizan estimaciones del grosor de la capa lipídica mediante el estudio de los colores interferenciales. Resultados: Encontramos un mayor grosor de la capa lipídica, en comparación con el grupo control, en patologías como blefaritis seborreica, conjuntivitis seca, blefaroconjuntivitis crónica, conjuntivitis infecciosa y portadores de lentes de contacto. En patologías como ojo seco climático y ojo seco ambiental encontramos un menor grosor de la capa lipídica en comparación al grupo control. No encontramos diferencias estadísticamente significativas entre el grupo control y pacientes con conjuntivitis crónica simple y conjuntivitis atópica. Conclusiones: El grosor de la capa lipídica se altera en distintas situaciones clínicas que cursan con ojo seco. El estudio de los colores interferenciales es un método semicuantitativo, y no invasivo, que nos permite estimar de una forma sencilla el grosor de la capa lipídica de la película lagrimal. Por su fácil realización e interpretación creemos que debería incorporarse como un elemento más de estudio en el diagnóstico de ojo seco.

          Translated abstract

          Purpose: Measure the thickness of lacrimal fatty layer in several pathologies with ocular dryness , by the study of interferencial colours. Methods: A prospective study of 100 patients (50 males and 50 females), divided in ten groups was performed. The first nine groups had dry eye pathology, the other one was the control group of healthy patients. We measured with the slit lamp the fatty layer thickness by the study of interferencial colours. Results: We found a greater thickness of the fatty layer in patients with pathologies like seborrheic blepharitis, keratoconjunctivitis sicca, chronic blepharitis and contact lens wear, compared with the control group. Patients with climatic and ambiental dry eye had a thin fatty layer compared with the control group. We didn’t find statisticaly significative differences between control group and the patients with chronic conjunctivitis or atopic conjunctivitis. Conclusions: The thickness of the fatty layer changes in different dry eye pathologies. Interferencial colours study is a semiquantitative and non invasive method to measure the thickness of fatty layer of precorneal tear film. It´s easy to perform and interprete, so we must include this as a part of the dry eye diagnostic study.

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          Most cited references41

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          Ocular evaporation in meibomian gland dysfunction and dry eye.

          Secretions from the meibomian gland are believed to be important in reducing ocular surface water evaporation and preventing dry eye. Patients with blepharitis frequently have meibomian gland dysfunction with loss of meibomian glands (drop out). The authors hypothesized that dry eye that often occurs in patients with chronic blepharitis is secondary to increased evaporation associated with gland loss. The authors measured the ocular surface water evaporation and tear osmolarity of patients with meibomian gland drop out and patients with gland drop out with a low Schirmer test. These findings were compared with those of a control group. The authors found that eyes with meibomian gland drop out and those with drop out and a low Schirmer test had a significantly higher evaporative rate at 30% relative humidity (average, 49.9 +/- 21 x 10(-7) g/cm2/second, or 0.49 +/- 0.29 microliters/minute evaporative loss per eye, and 59.1 +/- 28 x 10(-7) g/cm2/second, or 0.58 +/- 0.23 microliters/minute, respectively) when compared with those in the control group (average, 14.8 +/- 6 x 10(-7) g/cm2/second, or 0.15 +/- 0.07 microliters/minute [P < 0.05]). There was a significant correlation between evaporative rate and gland drop out (r = 0.522). Patients with meibomian gland drop out, and especially those with low tear production by Schirmer test, have an increased risk of dry eye developing through increased evaporation.
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            Correlation of tear lipid layer interference patterns with the diagnosis and severity of dry eye.

            To observe and classify tear film lipid layer interference patterns in normal volunteers and dry eye patients and to investigate the relation between the lipid layer interference patterns in the dry eyes and the results of other dry eye examinations. Precorneal tear lipid layer interference patterns were observed at the central cornea in 25 eyes of 13 normal controls and 85 eyes of 48 dry eye patients. Observed patterns were classified in masked fashion by five physicians into five grades: grade 1, somewhat gray color, uniform distribution; grade 2, somewhat gray color, nonuniform distribution; grade 3, a few colors, nonuniform distribution; grade 4, many colors, nonuniform distribution; and grade 5, corneal surface partially exposed. Other methods of dry eye examination were also performed, including the cotton thread test, the Schirmer I test and modified Schirmer I test, measurement of tear film breakup time, scoring of corneal fluorescein staining density (grades 0 to 3) and area (grades 0 to 3), and rose bengal staining (grades 0 to 9). In 92 (84%) of 110 eyes, four or more of the five physicians agreed in their grade classifications. Among the 92 eyes, normal control eyes were classified into grades 1 and 2 (10 and 12 eyes, respectively) and dry eyes were classified into grades 2, 3, 4, and 5 (22, 26, 10, and 12 eyes, respectively). There was a significant correlation between the grading and the results of other dry eye examination modalities, including fluorescein staining, rose bengal staining, and tear film breakup time. Tear lipid layer interference patterns are highly correlated with dry eye severity.
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              The thickness of the human precorneal tear film: evidence from reflection spectra.

              Interferometric methods have considerable potential for studying the thickness of layers of the human tear film and cornea because of their ability to make noninvasive, accurate, and rapid measurements. However, previous interferometric studies by Prydal and Danjo yielded tear thickness values near 40 and 11 microm, respectively, considerably greater than estimates made by invasive methods of 4 to 8 microm. Using a modified version of Danjo's method, interference effects from the tear film and cornea were studied, with the aim of correlation with known structure and optical properties of the cornea and hence determining the most probable value of tear film thickness. Reflectance spectra from the human cornea were measured at normal incidence. These spectra show oscillations whose maxima correspond to constructive interference between light reflected from the air surface and from some deeper surface. The frequency of these spectral oscillations is proportional to the thickness of the layer between the air surface and the second surface. Therefore, Fourier analysis of reflectance spectra can be used to determine the thickness of layers of the tear film and cornea. In the main experiment, 36 low-resolution spectra were obtained from six normal eyes for measuring thickness up to 100 microm. Control experiments included measurements of the time course of thickness changes and high-resolution spectra for measuring thickness up to 1000 microm. For the main experiment, in the thickness range 1 to 100 microm, the strongest peak in the Fourier transform was near 3 microm (range, 1.5-4.7 microm) beneath the air surface. In the range 20 to 100 microm, the strongest peak was near 55 microm (range, 50-59 microm) for all 36 spectra; none were in Prydal's range near 40 microm. This 55-microm peak is consistent with a reflection from the basement membrane of the epithelium. Time course measurements after a blink show that the 3-microm peak is not an artifact. High-resolution spectra gave a peak near 510 microm, corresponding to the complete thickness of the cornea (plus tear film). This peak had a contrast similar to that of the 3-microm peak. These studies did not confirm Prydal's estimate of approximately 40 microm. Nor were there prominent peaks near Danjo's value of approximately 11 microm, except in cases of probable reflex tears. Because the reflection at the aqueous-mucus boundary would be expected to be weaker than that from the epithelial surface, the 3-microm peak is unlikely to correspond to the aqueous layer (rather than the complete tear film). The proposal that the 3-microm peak corresponds to a reflection from the front of the cornea is supported by the demonstration of a peak of similar contrast from the back of the cornea. Thus, the current evidence consistently supports a value of approximately 3 microm for the thickness of the human precorneal tear film.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                aseo
                Archivos de la Sociedad Española de Oftalmología
                Arch Soc Esp Oftalmol
                Sociedad Española de Oftalmología (, , Spain )
                0365-6691
                May 2003
                : 78
                : 5
                : 257-264
                Affiliations
                [01] Madrid orgnameHospital General de Cruz Roja España
                Article
                S0365-66912003000500005
                10.4321/s0365-66912003000500005
                0ca70aab-e63d-4e31-9a7d-88b59fce1a0a

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 14 August 2002
                : 10 April 2003
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 33, Pages: 8
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                SciELO Spain


                Colores interferenciales,interferometría,grosor capa lipídica,ojo seco,Interference colours,interferometry,fatty layer thickness,dry eye

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