The lipid layer and stability of the preocular tear film in newborns and infants.

PURPOSE To measure the thickness of the precorneal lipid layer and the stability of the precorneal tear film in neonates and infants in the first 6 postnatal months. DESIGN Prospective, observational case series. PARTICIPANTS One hundred ninety-eight neonates and infants in the newborn nursery. METHODS The Keeler Tearscope Plus (Keeler Instruments Inc., Broomall, PA) was used to evaluate lipid layer thickness by interference fringe biomicroscopy and directly to measure noninvasive tear breakup time (NIBUT). The thickness was classified from level 1 (open meshwork-very thin) to level 9 (colored fringe pattern-very thick). MAIN OUTCOME MEASURES Noninvasive tear breakup time in seconds and classification level of lipid layer thickness. RESULTS The mean lipid layer classification for all newborns was 8.3 +/- 0.9, with no significant difference between genders. The thickest classifications (levels 8 and 9) were found in 83.3% of all infants. At 3 and 6 postnatal months, all infants studied had a lipid layer classification of 9. Mean NIBUT was 32.5 +/- 5.2 seconds (range, 17.6-48.5 seconds) and was not significantly different whether stratified by race, postconceptional age, or birthweight. However, although NIBUT was longer in males at birth (35.1 +/- 4.2 seconds versus 29.4 +/- 4.5 seconds; P < 0.001), it was equal in both genders at 3 and 6 postnatal months. CONCLUSIONS In the first 6 postnatal months, the lipid layer of the tear film is much thicker than in adults. The NIBUT in newborns is prolonged compared with adult values. This thick lipid layer in infants provides stability that may help prevent the thin aqueous layer from evaporating.

[1]  S. Shuster,et al.  Control and function of sebaceous glands. , 1989, Physiological reviews.

[2]  B. Cullen,et al.  NEWBORNS DO SECRETE TEARS. , 1964, JAMA.

[3]  P Cho,et al.  Review of the Tear Break-Up Time and a Closer Look at the Tear Break-Up Time of Hong Kong Chinese , 1993, Optometry and vision science : official publication of the American Academy of Optometry.

[4]  D R Korb,et al.  Survey of Preferred Tests for Diagnosis of the Tear Film and Dry Eye , 2000, Cornea.

[5]  S. Isenberg,et al.  Growth of the conjunctival fornix and orbital margin in term and premature infants. , 1987, Ophthalmology.

[6]  D. Möbius,et al.  Biophysical behaviour of the infant Meibomian lipid layer , 2004, International Ophthalmology.

[7]  S. Mishima,et al.  SOME PHYSIOLOGICAL ASPECTS OF THE PRECORNEAL TEAR FILM. , 1965, Archives of ophthalmology.

[8]  S. Liao,et al.  Androgen receptor expression in the preputial gland and its sebocytes. , 1994, The Journal of investigative dermatology.

[9]  M. Guillon,et al.  Preocular Tear Film Characteristics of Nonwearers and Soft Contact Lens Wearers , 1997, Optometry and vision science : official publication of the American Academy of Optometry.

[10]  F. J. Rocha,et al.  Androgens and Dry Eye in Sjögren's Syndrome a , 1999, Annals of the New York Academy of Sciences.

[11]  S. Isenberg,et al.  The pupils of term and preterm infants. , 1989, American journal of ophthalmology.

[12]  A. Tomlinson,et al.  Importance of the Lipid Layer in Human Tear Film Stability and Evaporation , 1997, Optometry and vision science : official publication of the American Academy of Optometry.

[13]  P Cho,et al.  The Relation between Invasive and Noninvasive Tear Break-Up Time , 1995, Optometry and vision science : official publication of the American Academy of Optometry.

[14]  L S Mengher,et al.  Effect of fluorescein instillation on the pre-corneal tear film stability. , 1985, Current eye research.

[15]  S. Isenberg,et al.  Development of tearing in preterm and term neonates. , 1998, Archives of ophthalmology.

[16]  P. Agache,et al.  Sebum levels during the first year of life * , 1980, The British journal of dermatology.

[17]  I. Toda,et al.  Identification of androgen receptor protein and 5α-reductase mRNA in human ocular tissues , 2000, The British journal of ophthalmology.

[18]  M. Doane,et al.  Abnormalities of the structure of the superficial lipid layer on the in vivo dry-eye tear film. , 1994, Advances in experimental medicine and biology.

[19]  M. Doane,et al.  An instrument for in vivo tear film interferometry. , 1989, Optometry and vision science : official publication of the American Academy of Optometry.

[20]  S. Isenberg.  Macular development in the premature infant. , 1986, American journal of ophthalmology.

[21]  J. Strauss,et al.  The effect of androgens and estrogens on human sebaceous glands. , 1962, The Journal of investigative dermatology.

[22]  E. Hegyi,et al.  The nature of the allergen in the manufacture of hexachlorocyclohexane. , 1962, The Journal of investigative dermatology.

[23]  J. McCulley,et al.  A compositional based model for the tear film lipid layer. , 1997, Transactions of the American Ophthalmological Society.

[24]  J. Mainstone,et al.  Relationship between tear-meniscus parameters and tear-film breakup. , 1997, Cornea.

[25]  T. Zimmerman,et al.  Textbook of ocular pharmacology , 1997 .