Interfacial Dilatational Viscoelasticity of Human Meibomian Lipid Films

A biophysical study of tear film lipid layer model membranes

The tear film lipid layer (TFLL), the final layer of the human tear film is responsible for surface tension reduction while blinking, water evaporation retardation and maintaining the stability of the tear film. The study of the composition-structure-function relationship of TFLL is paramount, as a compromised structure of TFLL leads to the emergence of dry eye disease (DED) which is one the most prevalent ophthalmic surface diseases of the modern world, associated with chronic pain and reduced visual capability. In this model membrane study, a systematic approach is used to study the biophysical properties of TFLL model membranes as a function of composition. Three mixed-lipid model membranes are studied along with their individual components comprising cholesteryl oleate (CO), glyceryl trioleate (GT), L-α-phosphatidylcholine (egg PC) and a free fatty acid mixture. The models become progressively more complex from binary to quaternary mixtures, allowing the role of each individual lipid to be derived. Langmuir balance, Brewster Angle Microscopy (BAM) and Profile Analysis Tensiometer (PAT) are used to study the surface activity and compression-expansion cycles, morphology, and rheological behaviour of the model membranes, respectively. Evidence of multilayering is observed with inclusion of CO and a reversible collapse is associated with the GT phase transition. An initially more coherent film is observed due to the addition of polar PC. Notably, these individual behaviours are retained in the mixed films and suggest a possible role for each physiological component of TFLL.

Biophysical properties of tear film lipid layer I. Surface tension and surface rheology

Tear film lipid layer (TFLL) is the outmost layer of the tear film. It plays a crucial role in stabilizing the tear film by reducing surface tension and retarding evaporation of the aqueous layer. Dysfunction of the TFLL leads to dysfunctional tear syndrome, with dry eye disease (DED) being the most prevalent eye disease, affecting 10%-30% of the world population. To date, except for treatments alleviating dry eye symptoms, effective therapeutic interventions in treating DED are still lacking. Therefore, there is an urgent need to understand the biophysical properties of the TFLL with the long-term goal to develop translational solutions in effectively managing DED. Here, we studied the composition-function correlations of an artificial TFLL, under physiologically relevant conditions, using a novel experimental methodology called constrained drop surfactometry. This artificial TFLL was composed of 40% behenyl oleate and 40% cholesteryl oleate, representing the most abundant wax ester and cholesteryl ester in the natural TFLL, respectively, and 15% phosphatidylcholine and 5% palmitic-acid-9-hydroxy-stearic-acid (PAHSA), which represent the two predominant polar lipid classes in the natural TFLL. Our study suggests that the major biophysical function of phospholipids in the TFLL is to reduce the surface tension, whereas the primary function of PAHSA is to optimize the rheological properties of the TFLL. These findings have novel implications in better understanding the physiological and biophysical functions of the TFLL and may offer new translational insight to the treatment of DED.

[Blepharitis component of dry eye syndrome]

This review contains a compilation of long-standing and more recent relevant information on chronic blepharitis, especially in the context of dry eye disease regarding epidemiology, symptoms, clinical findings and pathophysiology. Chronic blepharitis often represents the underlying cause of dry eye disease but remains undetected and untreated in many cases; however, it can be a result of (hypovolemic) dry eye disease and leads to sometimes severe corneal complications, which are illustrated by material from our own patient archives. Recent findings regarding the lipid composition in the tear film in correlation with that of Meibomian gland secretions and the hypothesis of a biofilm as the basis of chronic blepharitis as a theoretical, not yet proven addition to the previously known pathophysiological factors, are discussed.

Structure-function relationship of tear film lipid layer: A contemporary perspective

Tear film lipid layer (TFLL) stabilizes the air/tear surface of the human eye. Meibomian gland dysfunction (MGD) resulting in quantitative and qualitative modifications of TFLL major (>93%) component, the oily secretion of meibomian lipids (MGS), is the world leading cause of dry eye syndrome (DES) with up to 86% of all DES patients showing signs of MGD. Caused by intrinsic factors (aging, ocular and general diseases) and by extrinsic everyday influences like contact lens wear and extended periods in front of a computer screen, DES (resulting in TF instability, visual disturbances and chronic ocular discomfort) is the major ophthalmic public health disease of the present time affecting the quality of life of 10-30% of the human population worldwide. Therefore there is a pressing need to summarize the present knowledge, contradictions and open questions to be resolved in the field of TFLL composition/structure/functions relationship. The following major aspects are covered by the review: (i) Do we have a reliable mimic for TFLL: MGS vs contact lens lipid extracts (CLLE) vs lipid extracts from whole tears. Does TFLL truly consist of lipids only or it is important to keep in mind the TF proteins as well?; (ii) Structural properties of TFLL and of its mimics in health and disease in vitro and in vivo. How the TFLL uniformity and thickness ensures the functionality of the lipid layer (barrier to evaporation, surface properties, TF stability etc.); (iii) What are the main functions of the TFLL? In this aspect an effort is done to emphasize that there is no single main function of TFLL but instead it simultaneously fulfills plethora of functions: suppresses the evaporation (alone or probably in cooperation with other TF constituents) of the aqueous tears; stabilizes (due to its surface properties) the air/tear surface at eye opening and during the interblink interval; and even acts as a first line of defense against bacterial invasion due to its detergency action on the bacterial membranes. An effort is done to highlight how the concept on the importance of TFLL and TF viscoelasticity transpires from old and new studies and what are its clinical implications. An attempt is made to outline the future hot directions of research into the field ranging from quest for molecules that can significantly alter TFLL properties to addressing open questions on the contribution of TFLL to the overall performance of the TF.

TFOS DEWS II Tear Film Report

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.

Dynamic interfacial properties of human tear-lipid films and their interactions with model-tear proteins in vitro

This review summarizes the current state of knowledge regarding interfacial properties of very complex biological colloids, specifically, human meibum and tear lipids, and their interactions with proteins similar to the proteins found in aqueous part of human tears. Tear lipids spread as thin films over the surface of tear-film aqueous and play crucial roles in tear-film stability and overall ocular-surface health. The vast majority of papers published to date report interfacial properties of meibum-lipid monolayers spread on various aqueous sub-phases, often containing model proteins, in Langmuir trough. However, it is well established that natural human ocular tear lipids exist as multilayered films with a thickness between 30 and 100nm, that is very much disparate from 1 to 2nm thick meibum monolayers. We employed sessile-bubble tensiometry to study the dynamic interfacial and rheological properties of reconstituted multilayered human tear-lipid films. Small amounts (0.5-1μg) of human tear lipids were deposited on an air-bubble surface to produce tear-lipid films in thickness range 30-100nm corresponding to ocular lipid films. Thus, we were able to overcome major Langmuir-trough method limitations because ocular tear lipids can be safely harvested only in minute, sub-milligram quantities, insufficient for Langmuir through studies. Sessile-bubble method is demonstrated to be a versatile tool for assessing conventional synthetic surfactants adsorption/desorption dynamics at an air-aqueous solution interface. (Svitova T., Weatherbee M., Radke C.J. Dynamics of surfactant sorption at the air/water interface: continuous-flow tensiometry. J. Colloid Interf. Sci. 2003;261:1170-179). The augmented flow-sessile-bubble setup, with step-strain relaxation module for dynamic interfacial rheological properties and high-precision syringe pump to generate larger and slow interfacial area expansions-contractions, was developed and employed in our studies. We established that this method is uniquely suitable for examination of multilayered lipid-film interfacial properties. Recently it was compellingly proven that chemical composition of human tear lipids extracted from whole tears is substantially different from that of meibum lipids. To be exact, healthy human tear lipids contain 8-16% of polar lipids, similar to lung lipids, and they are mostly double-tailed phospholipids, with C16 and longer alkyl chains. Rationally, one would assume that the results obtained for meibum lipids, devoid of surface-active components such as phospholipids, and, above all, in a form of monolayers, are not pertinent or useful for elucidating behavior and stability of an averaged 60-nm thick ocular tear-lipid films in vivo. The advantage of sessile-bubble technique, specifically, using a small amount of lipids required to attain multilayered films, unlocks the prospect of evaluating and comparing the interfacial properties of human tear lipids collected from a single individual, typically 100-150μg. This is in sharp contrast with several milligrams of lipids that would be required to build equally thick films for Langmuir-trough experiments. The results of our studies provided in-depth understanding of the mechanisms responsible for properties and stability of human tear-lipid films in vivo. Here we summarize recent publications and our latest findings regarding human tear-lipid interfacial properties, their chemical composition, and their interaction with model proteins mimicking the proteins found in human tear-aqueous phase.

The real reason for having a meibomian lipid layer covering the outer surface of the tear film - A review

This review critically evaluates a broad range of literature in order to show the relationship between meibum, tear lipids and the tear film lipid layer (TFLL). The relationship of meibum composition to dry eye syndrome is briefly discussed. The review also explores the interactions between aqueous and the TFLL by examining the correlations between meibomian lipids and lipids extracted from whole tears, and by considering protein adsorption to the TFLL from the aqueous. Although it is clear to the authors that a normal tear film resists evaporation, an emerging idea from the literature is that the main purpose of the TFLL is to allow the spread of the tear film and to prevent its collapse onto the ocular surface, rather than to be an evaporative blanket. Current models on the possible structure of the TFLL are also examined.