title: Subjective and objective variation of the tear film pre- and post-sleep.
abstract: OBJECTIVE
  To date, few studies have correlated the overnight effects of the preocular tear film (POTF) with subjective symptoms. This study investigates the POTF volume and stability, bulbar hyperemia (BH), tear ferning (TF) and the participant's subjective symptoms, pre- and post-sleep.
  
  
  METHODS
  Thirty subjects were recruited, consisting of two evenly distributed groups who were symptomatic of dry eye (DE) and those that were asymptomatic dry eye, determined using the McMonnies questionnaire. Subjects were evaluated at 10 p.m. (baseline), on waking at 7 a.m., and then hourly until 10 a.m. At each visit, tear meniscus height (TMH), various subjective factors, BH and POTF stability by non-invasive break-up time (NIBUT) were assessed. Tear collection was performed at 10 p.m, 7 and 10 a.m. for TF analysis.
  
  
  RESULTS
  With the exception of burning, all other symptoms (comfort, dryness, clarity of vision, and grittiness) revealed an overnight change (p < 0.05) within each group, but not between the two groups (p > 0.05). Both the tear meniscus height and BH were elevated upon waking and differed significantly between test times for each group (p < 0.05), but not between groups (p > 0.05). NIBUT was lower for the DE group (p < 0.001). The non-dry eye (NDE) group did not significantly alter over time (p > 0.05), but the DE group did (p = 0.004), with a longer NIBUT in the morning. TF demonstrated a degraded pattern upon waking for both groups (p < 0.05). Most of the changes returned to baseline within an hour after waking.
  
  
  CONCLUSIONS
  The properties of the POTF undergo a change during extended periods of eye closure and the human POTF is different upon waking to that present immediately before sleep. Most of the parameters determined rapidly revert to baseline levels once the POTF is allowed to refresh.
authors.affiliation: Ecole d'optométrie, Université de Montréal, Montreal, Quebec, Canada. etty.bitton@umontreal.ca
authors.forename: Etty
authors.initials: E
authors.lastname: Bitton
authors.forename: Adam
authors.initials: A
authors.lastname: Keech
authors.forename: Lyndon
authors.initials: L
authors.lastname: Jones
authors.forename: Trefford
authors.initials: T
authors.lastname: Simpson
mesh_terms: D000328:Adult; D003941:Diagnostic Techniques, Ophthalmological; D015352:Dry Eye Syndromes / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D012890:Sleep; D013666:Tears / Q000737:chemistry* / Q000502:physiology*