The lipid layer and stability of the preocular tear film in newborns and infants.
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.
Isenberg
Sherwin J
SJ
Department of Ophthalmology, Jules Stein Eye Institute, U.C.L.A. School of Medicine, Los Angeles, California, USA. isenberg@ucla.edu
Del Signore
Madeline
M
Chen
Anthony
A
Wei
Jeffrey
J
Guillon
Jean-Pierre
JP
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
D008055:Lipids