title: The lipid layer and stability of the preocular tear film in newborns and infants.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective, observational case series.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
authors.affiliation: Department of Ophthalmology, Jules Stein Eye Institute, U.C.L.A. School of Medicine, Los Angeles, California, USA. isenberg@ucla.edu
authors.forename: Sherwin J
authors.initials: SJ
authors.lastname: Isenberg
authors.forename: Madeline
authors.initials: M
authors.lastname: Del Signore
authors.forename: Anthony
authors.initials: A
authors.lastname: Chen
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Wei
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Guillon
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007765:Lacrimal Apparatus / Q000502:physiology*; D008055:Lipids / Q000502:physiology*; D008297:Male; D011446:Prospective Studies; D013666:Tears / Q000502:physiology*; D014835:Volatilization
chemical_list: D008055:Lipids