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In Vivo Confocal Microscopy in the Diagnosis and Management of Dry Eye: A Focus on Imaging Protocols and Interpretation
Published on: November 11, 2025
503
Tear-film-oriented diagnosis for dry eye
Norihiko Yokoi1, Georgi As Georgiev2
1Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan. nyokoi@koto.kpu-m.ac.jp.
Japanese Journal of Ophthalmology
|February 21, 2019
Summary
Tear-film (TF) instability causes dry eye. A new layer-by-layer diagnosis and therapy (TFOD/TFOT) approach stabilizes the tear film by identifying and supplementing deficient ocular surface components, improving dry eye treatment.
Area of Science:
- Ophthalmology
- Ocular Surface Disease
- Dry Eye Disease
Background:
- Tear-film (TF) stability is crucial for ocular surface health, preventing desiccation.
- Insufficient or impaired ocular surface components lead to TF breakup, initiating dry eye.
- New eye drops in Japan target TF stabilization by supplementing deficient components.
Purpose of the Study:
- Introduce the concept of tear-film-oriented diagnosis (TFOD) and tear-film-oriented therapy (TFOT).
- Explain TFOD's basis in TF dynamics and breakup patterns (BUPs) for diagnosing dry eye subtypes.
- Highlight the layer-by-layer approach to identify and treat deficient ocular surface components.
Main Methods:
- Diagnosing dry eye subtypes (aqueous-deficient, decreased-wettability, increased-evaporation) using TF dynamics and BUPs.
- Analyzing BUPs and diagnosed subtypes to pinpoint insufficient ocular surface components.
- Proposing topical TFOT by supplementing identified deficient components to address TF breakup.
Main Results:
- TF breakup is recognized as a core mechanism in dry eye pathogenesis in Japan.
- Abnormal breakup time (≤5 seconds) and symptoms are key diagnostic criteria for dry eye.
- TFOD and TFOT offer a targeted, layer-by-layer strategy for dry eye management.
Conclusions:
- TF instability is a primary manifestation of dry eye.
- Understanding the molecular mechanisms of TF breakup is essential.
- TFOD and TFOT provide a framework for effective dry eye treatment through component supplementation.
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