Various surfacechemical interactions among the corneal epithelium, ocular mucous gel, tear film and tear film contaminants (e.g., cellular debris, lipids, bacteria) are characterized based on their apolar and polar (acid-base) surface properties. Based on this approach, the surfacechemical pathways of the tear film breakup and of the corneal epithelial lubrication, cleansing, wetting and defense are proposed. A strong monopolar repulsion keeps mucus in the form of a highly hydrated gel. which cannot adhere to the normal glycocalix carrying epithelial surface. but forms an effective surfacechemical trap for the apolar and weakly polar hydrophobic contaminants. However, mucusdeficiency andlor a host of epithelial surface abnormalities (e.g., increased cell loss, chemical or morphologic changes, damage) can initiate a vicious cycle comprising of factors such as: increased mucus contamination, loss of mucus and epithelial hydrophilicity, abnormal adhesion and aggregation of mucus. reduced mucus mobility and faulty surface cleansing. All of these faclors can conspire to produce a chronically unstable tear film secondary to the loss of corneal surface wettability. Copyright0 1998 by Marscl Dskkcr, Ine.Downloaded by [New York University] at 00:55 01 August 2015
SHARMAThe major objective of this paper is to e!xplore the surface-chemical mechanisms re:;ponsible for the maintenance of the corneal wetting by the tear film in rlormal eyes, and for a rapid breakup of the tear film seen in association with a variety of dry eye syndromes (1,2). A holistic understanding c)f the sequence of events leading to the tear film1 breakup has remained elusive even after three decades of intense activity in this area. What appears certain is that the tear breakup is secondary to the nonwettability of the c.orneal surface, which is nearly a tautological statement. Indeed, numerous experimental (3-7) and theoretical (4-9) studies have conclusively demonstrated that even relatively thick (-100 pm) liquid films on norwettable substrates can dewet spontaneously by the nucleation and growth of initial defects or dry spots.In the context of tear film breakup, however, there are several unanswered questions. What factors are responsible for maintaining the corneal surface wettability in health'? More importantly, what triggers its nonwettability by the aqueous tears in a variety of ocular surface and tear film disorders? As will be argued in this paper, the answers are not likely to be straightforward in that they involve subtle interplays of-surfacechemical and physiological factors. To address these questions in a meaningful way, a proper understanding of both the apolar and the polar (acid-base) surface properties of th~e corneal epithelium and mucus is required. While the early approaches (1 0-12) based on Zisman's method of critical surfacle tension (13) did produce some limited insights, it is now generally agreed that this method lacks the requisite framework to address the problem 04 polar interactions in aqueous media. Further progress ...