PURPOSE. We evaluated quantitatively direct effects of ceramide (Cer) and free cholesterol (FC) on meibomian lipid films (MLF) using a Langmuir trough (LT) and a Brewster angle microscope (BAM).
METHODS. Meibum was obtained from healthy volunteers. A series of mixtures of meibum with Cer or FC (mixed MLF)taken in different ratios were tested. Standard rheologic parameters, such as elasticity and hysteresis of MLF, were computed. BAM was used to study the morphology of MLF.RESULTS. Pure MLF were capable of withstanding multiple compression-expansion cycles with little hysteresis observed (~1.9 J/g meibum). The films made of either pure Cer or pure FC were clearly collapsible, and had much higher rigidity and hysteresis than pure meibum. Adding progressively higher amounts of Cer or FC to meibum had a strong impact on the rigidity, stability, and morphology of the mixed MLF: their hysteresis increased many fold compared to pure meibum. A concomitant increase in the rigidity and collapsibility of the mixed MLF was observed.CONCLUSIONS. Cer and FC changed the surface properties of mixed MLF in a way that implied their destabilization and/or disruption. One of the mechanisms that might lead to these effects is strong aggregation of meibum lipids with FC or Cer that leads to the formation of smaller particles of meibum surrounded by a thinner layer of FC or Cer. As Cer and FC can be elevated in meibum and the tear film because of certain pathologic processes, or can be of exogenous nature, our results can explain (partially) a less stable tear film in those subjects. (Invest Ophthalmol Vis Sci. 2013;54:1352-1360) DOI:10.1167/iovs.12-10662 T he preocular tear film (TF) is a complex aqueous structure that is enriched with lipids, proteins, carbohydrates and other molecules of biological origin. TF covers the entire ocular surface.1 The outermost layer of the tear film, also called tear film lipid layer (TFLL), is formed predominantly from a mixture of lipids called ''meibum.'' Meibum is produced by holocrine lipid-secreting meibomian glands (MG), which are located in the tarsal plates of the eyelids. [2][3][4] This outer layer is believed to prevent the evaporation of the TF, lubricate the ocular surface, and avert the invasion of pathogenic microorganisms. 5 Reportedly, adverse changes in the lipid composition of meibum 6-12 could impact negatively the integrity and stability of the TF, compromising the health of the ocular surface, and predisposing it to the development of various ocular pathologies. One of the latter, the dry eye disease (DED), is one of the most prevalent ocular diseases. One of the forms of DED is known commonly as meibomian gland dysfunction (MGD), 13 while another common condition that is associated with meibum and TFLL abnormalities is chronic posterior blepharitis (CPB). 14 Comprehensive chemical analyses of normal (i.e., non-dry eye) meibum samples collected from healthy subjects have demonstrated a very complex nature of meibomian lipids. Many lipid classes were shown to be present in normal ...