Flap motility sign: not diagnostic of posterior extension of anterior capsular tears.

Flap motility sign has been recently described as an aid to guide the surgeons regarding the feasibility of continuing safe phacoemulsification in the presence of peripheral extension of anterior capsular tears. While this sign may seem to provide a safety assurance to the operating surgeon who at such times may be under considerable stress, we believe, this sign may not always hold true and this hypothesis needs further investigation. We present a case in which an everted and fluttering flap was noted in the presence of a complete posterior extension of the anterior capsular tear, thus refuting the accuracy of flap motility sign.

Prevalence of corneal astigmatism before cataract surgery in Indian population.

The purpose of the study was to assess the prevalence of corneal astigmatism before cataract surgery in Indian population. The setting of this study was at the Sant Sarwan Dass Charitable Eye Hospital, Jalandhar, India. This is a clinic-based retrospective study. Charts of patients who underwent cataract surgery over a two-year period were retrospectively reviewed, and preoperative keratometric measurements were collected and analyzed. The mean age of 2316 patients (2502 eyes) was 59.54 ± 10.96 years. The corneal astigmatism was less than 1.0 Dioptre (D) in 796 eyes (59.37 %), 1.0-1.99 D in 716 eyes (28.62 %), 2.0-2.99 D in 187 eyes (7.47 %) and more than 3.0 D in 114 eyes (4.56 %). The mean corneal astigmatism was 1.04 ± 1.04 D and showed a gradual increase with age after the fourth decade. The astigmatism was with-the-rule in 709 (28.34 %), against-the-rule in 1298 (51.88 %), and oblique in 598 (23.9 %) eyes. There was a shift in astigmatism from with-the-rule to against-the-rule with increase in age. Over 40 % of the Indian patients undergoing cataract surgery have more than 1.0 D of corneal astigmatism and may benefit from the use of toric intraocular lenses. These data can be useful in planning to make this technology available for the patients.

Ophthalmic manifestations of Paederus dermatitis.

PURPOSE: To report the pattern of ophthalmic manifestations associated with Paederus dermatitis (PD). SETTING: Department of Ophthalmology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India. DESIGN: Clinic-based retrospective study. METHODS: Medical charts of patients presenting to the eye clinic with clinical features consistent with the diagnosis of PD from May 1, 2014 to April 30, 2016 were retrospectively reviewed. Relevant demographic and clinical data of periocular and ocular findings were collected and analyzed. The patients with a history of chronic skin disorders or allergies were excluded from the study. RESULTS: A total of 56 patients were included in the study, of which 39 (69.6 %) were males. The age range was 4-65 years with a median of 27 years. On presentation, common subjective symptoms were burning sensation in 49 (87.5 %), itching in 37 (66.1 %), watering in 25 (44.6 %), foreign body sensation in 19 (33.9 %), blurring of vision in 17 (30.4 %), and photophobia in 12 (21.4 %) patients. Visual acuity at presentation was 20/20 in 39 (69.6 %) patients, between 20/30 and 20/80 in 9 (16.1 %) patients, and less than 20/80 in 8 (14.3 %) patients. Lid swelling, erythema, crusts, and vesicles were the common periocular findings; and conjunctival hyperemia, discharge, and corneal erosions were the common ocular findings. CONCLUSIONS: The current study shows that PD can cause significant ocular morbidity. Ophthalmologists, especially those who work in endemic areas, should be aware of this entity both in terms of management as well as for educating patients about the preventive measures.

Use of an autologous lamellar scleral graft to repair a corneal perforation.

To report the use of an autologous lamellar scleral graft to close a corneal perforation. Our patient was a 55-year-old female who presented with a paracentral 2 × 2 mm perforation in the center of a preexisting corneal opacity. Because of the unavailability of corneal tissue and the failure to seal the perforation with glue, a partial thickness lamellar scleral graft was harvested from the inferotemporal quadrant and used to close the corneal defect. There was gradual adherence and uptake of the scleral tissue into the surrounding cornea along with significant clearing over the next few months. At 9 months, her best-corrected visual acuity was 20/80 with a stable anterior chamber, focal posterior synechiae and early cataract changes. A band of iris tissue was observed within the lens substance extending posterolaterally from 1 to 7 o'clock positions. In the absence of donor corneal tissue and in selective emergency situations, an autologous scleral patch graft can be considered as a viable alternative in the treatment of full-thickness corneal perforations. We also report the presence of a band of iris tissue within the lens, a finding which has not been previously reported.

Measurement of dynamic pupillometry parameters in adult Indian population.

PURPOSE: To determine normative dynamic pupillometry data in healthy Indian adults and to investigate the effect of age on various pupillary parameters. METHODS: Pupillometry measurements were obtained on healthy participants using an automatic dynamic pupillometry device, the NPi-200 (NeurOptics Inc., Irvine, CA, USA). Various measurements, including neurologic pupil index (NPi), resting pupil size (Size), minimum pupil diameter (MIN), percentage change in pupil size (CH), constriction velocity (CV), maximum constriction velocity (MCV), latency (LAT), and dilatation velocity (DV), were obtained in routine clinical settings and analyzed statistically for change with age. RESULTS: A total of 470 participants (470 eyes) were analyzed. Mean NPi was 4.31 ± 0.31, Size was 4.38 ± 0.80 mm, MIN was 2.87 ± 0.49 mm, CH was 34.67 ± 4.15%, CV was 2.74 ± 0.68 mm/s, MCV was 4.16 ± 0.98 mm/s, LAT was 0.23 ± 0.02 s, and DV was 1.13 ± 0.25 mm/s. NPi and LAT were positively correlated (P < 0.01), whereas Size, MIN, CH, CV, MCV, and DV were negatively correlated with age (P < 0.01). No statistically significant difference was observed between males and females. CONCLUSION: The study offers normative data on dynamic pupillometry parameters across various age groups within a healthy Indian population, which would serve as a reference for future studies in diverse clinical scenarios. It also elucidates that age significantly influences values in the NPi algorithm.

Interdevice Agreement between a Smartphone and a Commercial Pupillometer.

Background: The reliability of dynamic pupillometry parameters varies from one pupillometer to another, making it difficult to standardize the values for any particular device. Hence, further studies are required to evaluate the agreement of various pupillometer devices and explore their utility in routine clinical settings. Aim: This study sought to evaluate the agreement between smartphone and commercial pupillometer measurements in routine clinical settings. Methods: The study included pupillary measurements obtained by a single investigator from 100 healthy participants (200 eyes) with each pupillometer. Pupillary measurements taken by a smartphone pupillometry application (reflex pupillary light reflex analyzer by Brightlamp [Indianapolis, IN, USA]) were compared with a commercial pupillometer (neurological pupil index-200, NeurOptics Inc., Irvine, USA). Results: The comparison of descriptive statistics revealed a statistically significant difference between the smartphone and commercial pupillometers for various parameters, including maximum diameter, minimum diameter, constriction velocity (CV), maximum CV, and dilatation velocity (P < 0.05), except for latency (P = 0.36). The intraclass correlation coefficient revealed poor agreement between the two devices (<0.50). Conclusion: The measurements by smartphone pupillometry application were found to be unreliable, indicating that they may not be an ideal substitute for commercial pupillometers in their present form in the Indian population. Further studies with larger sample size as well as improvements in the processing and interpretation of the measurements by the software, are needed to determine its utility in routine clinical settings.

Paediatric cornea crosslinking current strategies: A review.

Background: In the general population, 1 in 2000 people has keratoconus. Indians and other people from Southeast Asia have a higher incidence of keratoconus. Children with keratoconus typically present earlier in life and with a more severe disease. Rubbing the eyes has been identified as a risk factor. Children have a higher incidence and a faster rate of keratoconus progression. Visual rehabilitation in children with keratoconus is challenging. They have a low compliance with contact lens use. Many of these children require penetrating keratoplasty at an early age. Therefore, stopping the progression of keratoconus in children is of paramount importance. Main text: Compared to treatment, keratoconus progression prophylaxis is not only preferable, but also easier. Corneal collagen cross-linking has been shown to be safe and effective in stopping its progression in children. The Dresden protocol, which involves central corneal deepithelization (7-9 â€‹mm), saturation of the stroma with riboflavin (0.25%), and 30 â€‹min UV-A exposure, has proven to be the most successful. Two significant disadvantages of the typical Dresden regimen are the prolonged operating time and the significant post-operative pain. Accelerated-CXL (9 â€‹mW/cm2 x 10 â€‹min) has been studied to reduce operative time and has been shown to be equally effective in some studies. Compared to accelerated CXL or traditional CXL, epi-off procedures, transepithelial treatment without the need for de-epithelialization and without postoperative discomfort, have been shown to be safer but less effective. Corneal crosslinking should only be performed after treating children with active vernal keratoconjunctivitis. Corneal opacity, chronic corneal edema, sterile infiltrates, and microbial keratitis have been reported after cross-linking of corneal collagen. Conclusions: The "Dresden protocol", also known as the conventional corneal cross-linking approach, should be used to halt the progression of keratoconus in young patients. However, if the procedure needs to be completed more rapidly, accelerated corneal crosslinking may be considered. Transepithelial corneal cross-linking has been proven to be less effective at stabilizing keratoconus, although being more safer.

Effect of mydriatic eye drops (combined 0.8% tropicamide and 5% phenylephrine) on the measurements of corneal parameters using Pentacam.

Purpose: The purpose of the study is to investigate the effects of combined 0.8% tropicamide and 5% phenylephrine on the corneal parameters using Pentacam. Methods: The study was performed on 200 eyes of 100 adult patients visiting the ophthalmology clinic for evaluation of refractive errors or cataract screening. Mydriatic drops (Tropifirin; Java, India) containing tropicamide 0.8%, phenylephrine hydrochloride 5%, and chlorbutol 0.5% (as a preservative) were instilled into the eyes of the patients three times every 10 minutes. The Pentacam was repeated after 30 minutes. The measurement data of various corneal parameters from different Pentacam displays (keratometry, pachymetry, densitometry, and Zernike analysis) was manually compiled on an Excel spreadsheet and analyzed using Statistical Package for the Social Sciences (SPSS) 20 software. Results: Analysis of Pentacam refractive maps revealed a statistically significant increase (P < 0.05) in the values of radius peripheral (cornea front), pupil center Pachymetry, pachymetry apex, thinnest location Pachymetry, and cornea volume. However, pupil dilation did not affect the Q-value (asphericity). Analysis of the densitometry values revealed significant increase in all zones. Aberrations maps revealed statistically significant increase in the value of spherical aberration after the induction of mydriasis, but the values of Trefoil 0º, Trefoil 30º, Koma 90º, and Koma 0º were not affected significantly. We did not observe any untoward effect of the drug, except transient blurring of vision. Conclusion: The current study showed that routine mydriasis in the eye clinics leads to a significant increase in various corneal parameters including corneal pachymetry, cornea densitometry, and spherical aberration as measured by Pentacam, which can influence the decision-making in the management of various corneal diseases. The ophthalmologists should be aware of these issues and make adjustments in their surgical planning accordingly.

Acute corneal melt associated with topical bromfenac use.

PURPOSE: To report a case of acute corneal melt associated with use of bromfenac ophthalmic solution. METHODS: Case report. RESULTS: A 61-year-old man developed acute corneal melt 5 days after having combined cataract and pterygium surgery in his left eye. Postoperatively, he had been using bromfenac eyedrops four times daily along with the combination of ofloxacin and dexamethasone six times and timolol eyedrops twice daily. Ocular examination revealed the presence of asymptomatic dry eyes. He was managed conservatively with topical antibiotics, lubricants, and bandage contact lens application. The corneal melt healed completely with best-corrected visual acuity of 20/30 at 4 weeks postoperatively. CONCLUSIONS: The current case suggests that corneal melt can occur as a complication of inadvertent excessive use of topical bromfenac in the presence of preexisting ocular surface disorders. However, good visual outcome can be achieved by prompt conservative treatment if accurate diagnosis is made at an early stage.

Cataract surgery in a patient with unilateral cataracta membranacea.

Cataracta membranacea (CM) is a rare condition characterized by the remnants of lens capsules and fibrous proliferation that develops secondary to lens matter liquefaction and absorption. Although CM is usually bilateral and may be associated with other congenital anomalies and poor visual prognosis; it can rarely be seen in the adults with involvement of only one eye. Reported herein, is a case of 57-year-old man who presented with CM in his right eye and underwent successful in-the-bag intraocular lens implantation with good visual outcome.

Corneal higher-order aberrations after Descemet's stripping automated endothelial keratoplasty.

PURPOSE: To compare the corneal higher-order aberration (HOA) after Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PKP), and in age-matched controls. DESIGN: Cross-sectional, non-comparative interventional case series. PARTICIPANTS: Thirty-one eyes of 28 patients who underwent DSAEK, 20 eyes of 16 patients who underwent PKP, and 31 eyes of 31 control patients. INTERVENTION: The corneal topography and HOAs of the central 4- and 6-mm zones from anterior and posterior corneal surfaces were evaluated postoperatively with the Scheimpflug rotating imaging system (Oculus Gmbh, Wetzlar, Germany). MAIN OUTCOME MEASURES: Anterior and posterior corneal HOAs. RESULTS: The mean anterior corneal total HOAs of the central 4 and 6 mm were 0.599+/-0.288 microm and 1.215+/-0.496 microm, respectively, in eyes that underwent DSAEK; 1.730+/-0.826 microm and 3.349+/-1.490 microm, respectively, in eyes that underwent PKP; and 0.439+/-0.163 microm and 0.921+/-0.300 microm, respectively, in controls. Although the mean anterior corneal total HOAs of the central 4 and 6 mm were significantly higher in eyes that underwent PKP than in eyes that underwent DSAEK and in controls (P<0.01), there was no significant difference in anterior corneal total HOAs of the central 4 and 6 mm between eyes that underwent DSAEK and controls. The mean posterior corneal total HOAs of the central 4 and 6 mm were 3.680+/-1.586 microm and 7.142+/-3.011 microm, respectively, in eyes that underwent DSAEK; 2.957+/-1.238 microm and 5.314+/-2.095 microm, respectively, in eyes that underwent PKP; and 0.818+/-0.193 microm and 1.609+/-0.344 microm, respectively, in controls. Although there was no significant difference in posterior corneal total HOAs of the central 4 mm between the DSAEK group and the PKP group, the posterior corneal HOAs of the central 6 mm were significantly higher in the DSAEK group than in the PKP group (P<0.01). CONCLUSIONS: Although posterior corneal HOAs are significantly higher in eyes that underwent DSAEK, anterior corneal HOAs are not significantly different in eyes that underwent DSAEK than those of age-matched controls.

A silent nasal mass with ophthalmic presentation.

Nasal chondromesenchymal hamartoma (NCMH) is a rare benign pediatric hamartoma that can simulate malignancy. It is apt to be misdiagnosed because of the overlapping histologic features shared with a number of benign and malignant soft tissue tumors. Here we report a case of this clinical entity in a child of 2.5 years of age. NCMH is histologically characterized by a mixture of various mesenchymal elements, including spindle cells, collagen fibers and irregular islands of osseous and chondroid tissue. The tissue was immunosensitive to SMA and calponin. This tumor has a benign biological behavior, and complete resection is the treatment of choice. Awareness of this clinical entity is essential for correct diagnosis and to avoid potentially harmful therapies.

Molecular identification and phylogenetic relationship of Demodex mites based on mitochondrial 16S rDNA.

BACKGROUND AND OBJECTIVE: Demodex mites are tiny parasites that live around hair follicles of mammals. The two main species of Demodex i.e. Demodex folliculorum and Demodex brevis present in humans are found near the hair follicles of eyes. The present study was to understand the presence of Demodex mites in people suffering from blepharitis in Amritsar, Punjab. MATERIAL AND METHODS: Demodex mites samples present in blepharitis patients were isolated from the eyelashes. DNA was isolated from three mites and used for PCR amplification of mitochondrial (mt) 16S rDNA. The amplified PCR product were purified and used for molecular identification. RESULTS: The amplified mt16s rDNA product was sequenced and subjected to BLAST search in the NCBI database for molecular identification. The identified mite belongs to Demodex folliculorum species. The phylogenetic tree constructed by using mt16s rDNA sequence suggests that D. folliculorum is closer to D. canis than to D. brevis. CONCLUSION: All the three isolates belong to D. folliculorum and the mitochondrial DNA 16S rDNA partial sequence is applicable for phylogenetic relationship analysis.

Herpetic keratitis after descemet stripping automated endothelial keratoplasty for failed graft.

OBJECTIVES: To report a case of herpetic epithelial keratitis after Descemet stripping automated endothelial keratoplasty (DSAEK) for a failed graft. METHODS: A 31-year-old female patient underwent DSAEK for failed graft in left eye. She previously had undergone penetrating keratoplasty for keratoconus in that eye. RESULTS: One week after DSAEK, the patient presented with pain in left eye. The cornea showed two epithelial defects with dendritic edges that involved the penetrating keratoplasty graft host junction and showed positive fluorescein staining. Diagnosis of herpes simplex virus keratitis was made and the patient was started on oral acyclovir and topical trifluiridine. The epithelial lesions showed complete resolution in 3 days. CONCLUSIONS: Herpes simplex virus epithelial keratitis can occur after DSAEK for failed grafts even in the absence of previous history of herpes simplex virus infection and should be considered in the differential diagnosis of postoperative epithelial defects.

Tandem scanning confocal microscopy of cornea after descemet stripping automated endothelial keratoplasty.

PURPOSE: To evaluate the changes in the corneal stroma after Descemet stripping automated endothelial keratoplasty (DSAEK) using tandem scanning confocal microscopy (CM). METHODS: Thirteen eyes of 13 patients who underwent DSAEK without preoperative corneal haze or scar obvious at the slit lamp, any ocular disease, and postoperative complication were included in the study. All patients were examined clinically and by CM 6 months after DSAEK. RESULTS: Six months after DSAEK, none of the eyes had clinically significant interface haze (i.e., haze affecting quantity or quality of vision) at slit lamp. The mean best spectacle corrected visual acuity was 0.18 +/- 0.12 (range 0-0.4) logMAR (Snellen 20/30). The CM revealed highly reflective particles in interface in six eyes, particles with mild surrounding increased reflectivity in four eyes, and no discernible interface in three eyes. The mean particles density at interface was 28.6 +/- 23.4 particles/mm. No significant keratocyte activation was seen in any case at the interface. The mean anterior stromal reflectivity was 431.2 +/- 269.1 confocal back scatter units (CBU) and the mean interface reflectivity was 65.9 +/- 46.9 CBU. The mean anterior stromal reflectivity was significantly greater than the mean interface reflectivity (P<0.01). Significant keratocyte activation with high reflectivity was seen in superficial anterior stroma in 8 of 13 eyes. CONCLUSIONS: Tandem scanning CM shows the presence of highly reflective particles at the level of the DSAEK interface that are morphologically similar to a laser in situ keratomileusis interface. The stromal reflectivity is more prominent in subepithelial layers than that of interface 6 months after DSAEK. However, the areas under the mean reflectivity peaks (CBU) corresponding to the flap interface and superficial anterior stroma do not seem to correlate with best spectacle corrected visual acuity results after the procedure.

Evaluation of the role of ProKera in the management of ocular surface and orbital disorders.

OBJECTIVES: To report the efficacy and safety profile of sutureless and adhesiveless amniotic membrane device (ProKera, Bio-Tissue, Inc., Miami, FL) in the management of various ocular surface and orbital disorders. METHODS: Twenty eyes of 20 patients underwent placement of 21 ProKera implants between March 2006 and July 2007 at the University of Texas Southwestern Medical Center. Patient demographics, indications for placement, and duration of ProKera retention were recorded. Outcomes measured included corneal epithelial healing, visual acuity, patient tolerance, and adverse events. RESULTS: ProKera was most commonly used in patients with corneal neovascularization with or without limbal stem-cell deficiency (10 eyes). Other indications included recurrent pterygium or pseudopterygium (three eyes), anophthalmic orbit contraction (two eyes), persistent epithelial defects (two eyes), severe thinning in a corneal ulcer (one eye), benign hereditary intraepithelial dyskeratosis (one eye), and band keratopathy (one eye). The mean duration of ProKera retention was 25.3 days (range, 0-125) visual acuity improved in 12 eyes (60%). Immediate adverse events included residual epithelial defects after removal (five eyes) and spontaneous extrusion of the implant (four eyes). Six patients (30%) reported eye pain or headache and four eyes (20%) had recurrence of the primary pathology. CONCLUSIONS: Sutureless and adhesiveless amniotic membrane transplantation is a safe and effective method to promote healing and reconstruction of the ocular surface and orbit with minimal side effects. Recurrence of the underlying primary pathology remains a concern. The advent of a newer, softer conformer ring may improve patient tolerability and limit discomfort.

Ahmed tube exposure secondary to prokera implantation.

PURPOSE: To report a case of Ahmed tube exposure secondary to Prokera implantation. METHODS: Case report. RESULTS: We present a 48-year-old woman who developed tube erosion after penetrating keratoplasty and Prokera implantation for dense vascularized corneal scar. The patient subsequently underwent wound revision with repeat scleral patch graft and closure of the conjunctival defect. CONCLUSIONS: The case presented demonstrates that caution should be exercised in using this implant in patients who have irregular elevations of the ocular surface because of glaucoma drainage devices.

Solitary sclerotic fibroma as a rare cause of nasolacrimal duct obstruction.

PURPOSE: To report a case of solitary sclerotic fibroma (SF) as a rare cause of nasolacrimal duct obstruction. METHODS: A 47-year-old female presented with a mass in the right lacrimal sac region that was associated with intermittent watering, pain and itching, and showed delayed fluorescein clearance. CT scan showed a soft tissue density in the lacrimal sac region. The mass was completely excised and on histopathology showed a well-circumscribed fibrous nodule with eosinophilic collagen bundles arranged in an interweaving "plywood" pattern with elongated clefts between them, characteristic of SF. CONCLUSIONS: SF should be included in the differential diagnosis of nodular masses in the lacrimal sac region. Although most of SFs occur in the dermis and are asymptomatic, this case suggests that SF can produce symptoms and signs of clinical significance by virtue of its anatomic location in a confined space in proximity to other structures.

A study of pulmonary function in end-stage renal disease patients on hemodialysis: a cross-sectional study.

BACKGROUND: The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD) patients. DESIGN AND SETTING: Prospective study in tertiary-level care center. METHODS: Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions. RESULTS: The patients' average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94%) and hypoalbuminemia (72%) were common. Diabetes mellitus (68%), hypertension (34%) and coronary artery disease (18%) were major comorbidities. Forty-five patients (90%) had been on hemodialysis for six months to three years. The patients' pre-dialysis mean forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P < 0.01). The increase in mean FEV1/FVC, from 97.8 ± 20.8% to 99.3 ± 20.1% of predicted, was not significant (P > 0.05). The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05). The mean peak expiratory flow was below normal (43.8 ± 30.7%) and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05). Males and females showed similar directions of change after hemodialysis. CONCLUSIONS: Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved.

Tear lipocalin: evidence for a scavenging function to remove lipids from the human corneal surface.

PURPOSE: Lipid contamination of the cornea may create an unwettable surface and result in desiccation of the corneal epithelium. Tear lipocalin (TL), also known as lipocalin-1, is the principal lipid-binding protein in tears. TL has been shown to scavenge lipids from hydrophobic surfaces. The hypothesis that TL can remove contaminating fatty acids and phospholipids from the human corneal surface was tested. METHODS: TL was purified from pooled human tear samples by size exclusion and ion exchange chromatographies. Tears depleted of TL were reconstituted from fractions eluted by size exclusion chromatography that did not contain TL. Fresh and formalin-fixed human corneas were obtained from exenteration specimens. Fluorescent analogs of either palmitic acid or phosphatidylcholine were applied to the corneal epithelial surface. Tears, TL, or tears depleted of TL were applied over the corneas, and spectrofluorometry and fluorescent stereomicroscopy were used to monitor the removal of fluorescent lipids. Tears used in the experiments were then fractionated by size exclusion chromatography to determine the component of tears associated with fluorescent lipids. RESULTS: Significant enhancement of fluorescence for 16AP and NBD C(6)-HPC was evident in solutions incubated with whole tears and purified TL but not with tears depleted of TL for fixed and unfixed corneas. After the experiment, size exclusion fractions of tears showed that the fluorescence component coeluted with TL. CONCLUSIONS: TL scavenges lipids from the human corneal surface and delivers them into the aqueous phase of tears. TL may have an important role in removing lipids from the corneal surface to maintain the wettability and integrity of the ocular surface.