A tearscope made of paper?

A relatively simple device can help evaluate the lipid layer in tear film-related disease, according to researchers.

Reviewed by Ho Sik Hwang, MD, PhD

Gangwon-do, Korea-A new tearscope was easy to use when evaluating the lipid layer in tear film-related disease, said Ho Sik Hwang, MD.

The tearscope (Hosik’s Tearscope) was created to analyze the lipid layer in patients with dry eye syndrome, meibomian gland dysfunction (MGD), and ocular graft-versus-host disease (GVHD), said Dr. Hwang, assistant professor, Department of Ophthalmology, Chuncheon Sacred Heart Hospital College of Medicine, Hallym University, Gangwon-do, Korea.

The 3- x 6-cm device, made from everyday copy paper, was introduced by Dr. Hwang and fellow researchers Eunchul Kim, MD, and Man Soo Kim, MD, PhD.

For observation purposes, the researchers made a round 6-mm diameter hole at one-quarter end of the paper. They positioned the tearscope in front of the patient’s eye, 1 cm from the cornea. With use of the slit lamp, researchers looked for interference patterns on the cornea through the hole.

After adjusting for magnification, they captured images with a charge-coupled device camera connected to the slit lamp. Researchers also took photos of the upper lid margin and cornea stain patterns, and they measured tear breakup time (TBUT). They assessed the average lipid layer thickness by analyzing the colors of the interference patterns, Dr. Hwang said.

They also analyzed the relationship between lipid layer thickness and meibomian gland dropout and the relationship between lipid layer thickness and TBUT.

More dry eye: How punctal plugs may influence tear osmolarity and aid in dry eye therapies

Dr. Hwang and fellow researchers gathered tear film interference patterns from 238 patients with tear film-related disorders.

Tearscope results


Tearscope results

The results that researchers found provided some insights into tear film behavior.

In healthy subjects, there were gray meshwork, wave, or amorphous patterns. In patients with dry eye, thin gray patterns were often observed. In MGD or GVHD patients, a range of red to violet colors appeared along with globus or clumping in severe cases.

Taking photos of the lipid layer took less than 10 seconds, Dr. Hwang said.

Researchers were able to easily save the image files. Video of dynamic tear film changes during blinking could be saved as movie files.

Related dry eye: When old, new technologies converge for dry eye diagnosis


1. Hwang HS, Kim EC, Kim MS. Novel tear interferometer made of paper for lipid layer evaluation. Cornea. 2014;33:826-831.


Ho Sik Hwang, MD, PhD

E: huanghs@daum.net

This article was adapted from Dr. Hwang’s paper at the 2015 meeting of the American Society of Cataract and Refractive Surgery. The paper won a Best Paper of Session during the meeting. Dr. Hwang did not indicate any financial interest in the subject matter.


Related Videos
Related Content
© 2023 MJH Life Sciences

All rights reserved.