![]() ![]() Holly's model was based on the restricted knowledge at that time of factors such as tear thickness and evaporation rate. ![]() He therefore proposed that tear breakup was caused when the corneal epithelium became hydrophobic from diffusion of lipid from the tear film lipid layer, TFLL. 3 The use of the term “instability” is probably related to an early model of tear breakup due to Holly 4 who noted that water films over a hydrophobic surface can rupture spontaneously when their thickness is reduced to a few hundred micrometers. According to the Dry Eye Workshop 1 the two core mechanisms of dry eye are “tear film instability” and “tear hyperosmolarity.” Tear film instability is recorded as the time for “breakup” to occur after a blink, either by instilling fluorescein and observing the first dark spot in the fluorescent image 2 or by noninvasive observation of distortion/disruption of the tear film surface. ![]()
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