TEAR FILM

BY: SANIYA MHATRE

3rd YEAR
OPTOMETRIST
INTRODUCTION
 Tear film is a thin layer of fluid that covers
the ocular surface.
 It was 1st demonstrated by Fischer in 1982.
 Wolff was the 1st to describe detail structure
of tear film.
 He coined the term ‘PRE-CORNEAL FILM’
 It is the first media striking the light rays.
 Total volume of tear is 6.5-8.5ml .
LAYERS OF TEAR FILM
 There are three layers of tear film.
1. Lipid layer
2. Aqueous layer
3. Mucin layer
CONTINUE :-
 LIPID LAYER :
The upper oil layer seals the tear film and prevent
evaporation . It is the thinnest layer at 0.04 um.

 AQUEOUS LAYER :
It is comprised of water. It has thickness of 2-6
um .

 MUCIN LAYER :
It helps to adhere to the eye. It has thickness of
0.5 um.
FUNCTIONS OF TEAR FILM :-
 Tear film keeps the eye moist.
 It creates the smooth surface for light to
pass through the eye.
 Nourishes the front of the eye.
 It protects from infection and injury.
 Tear film makes safe and comfortable
contact lens wear.
 It gives high-quality vision.
 It protects cornea.
EXAMINATION OF TEAR FILM
 There are two kind of tear film assessment:

1. Tear volume : { Schirmer’s Test , Tear

Prism Height }
2. Tear film quality {tear break-up
time(TBUT), noninvasive tear break up time
(NIBUT), tear thinning time (TTT), Rose
Bengal test, PRTT }.
SCHIRMER’S TEST
 Bend the Schirmer’s strip at their notch.
 hook it over the nasal lower lid margin and
ask the patient to look up before insertion .
 This test done for 5 minute .
 Blinking is permitted during test .
 The adequacy of tear volume is measured by
the length of wet area of the filter strip.
 Values ranges from 5mm to more than 33mm
of wetting.
 Normal average value is 15mm of wetting in 5
minutes.
 There are two variations of the test :-
 Without topical Anesthesia – In
this, reading are taken without
anesthetic agent.

 With topical Anesthesia –

anesthetic agent are used . it
measure basal tear . Then put the
strip as used in the normal schirmer
test for 5 minutes . A normal
reading is approximately 10 mm in
this case.
TEAR PRISM HEIGHT
 The height and width of tear reservoir across
the lower lid margin can give a reasonable
assessment of tear volume.
 Use slit lamp and reduce the height of slit
beam and adjust to the horizontal postion.
 The approximate height of tear film at
centre in case of normal tear film is 0.2-
0.4mm.
 Reduced height suggest reduced tear volume
and increased height suggests poor drainage
system.
TEAR FILM BREAK-UP TIME
 It is a test to measure the relative stability
of the pre-corneal tear film.
 It is the time required for ocular to lose
surface wetting after each blink is referred
as the TBUT.
 Due to evaporation there is thinning of the
tear film which appear as a dark spot formed
when the film breaks up.
PROCEDURE:-
 Fluorescein is instilled onto the eye and tear
film is observed under “blue light”.
 It is observed under dim light.
 Tell the patient to blink fully and the stop
blinking.
 After that start counting in second till the
dark spot appears in the tear film.
 And then stop counting.
INTERPREATATION :-
 Greater than 10 sec is NORMAL.
 Less than 10 sec ABNORMAL.
PHENOL RED THREAD TEST:-

PROCEDURE:-
 It is the test done for dry eyes.
 The 70mm thread of phenol red is inserted in
lower part of eye for 15 sec.
 Eye closure is required after insertion.
 The wet length is measured and color change
is noted.
INTERPREATATION:-
 Average wet length is 16.7mm in 15sec.
 Wet length less than 6mm is considered as
dry eye patients.
NON-INVASIVE TEAR BREAK-UP
TIME
 NIBUT test is done to avoid any artifacts
resulting from fluorescein instillation.
 Using slit lamp does have some disadvantage.
 Light source of slit lamp gernerates heat ,
causing some evaporation of the tear film.
 Tearscope can be used instead of slit lamp.