Tränenfilm Lipid-Schicht Dicke
Normalwert: mindestens ≥ 65 ICU Einheiten (entspr. ca. 65nm) normal bis zu ca. 100 ICU
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Inkomplette Lidschläge – Störungen des Lidschlages
Normalwert: ca. 20% der Lidschläge (versch. Angaben in der Literatur)
Pathologisch: > 50% der Lidschläge inkomplett
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Tränenfilm-Stabilität - Break-Up Time (BUT) - Tränenfilm-Aufbruchs-Zeit (TAZ)
Nicht-Invasive BUT (NI-BUT)
Normalwert: mindestens ≥ 10 Sekunden
(bei NI-BUT sind die Normalwerte typischerweise höher, also längere Stabilität, da der Tränenfilm nicht durch Farbstoff gestört wird. Ni-BUT ist einfacher zu messen, komfortabler und liefert numerische Werte … theoretisch exakter, benötigt spezielle Geräte)
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=> zuverlässiger Standardtest ist der F-BUT mit Fluoreszein
mit Fluoreszein (F-BUT)
Normalwert: mindestens ≥ 10 Sekunden
(BUT mit Fluoreszein ist der internationale Standard auf dem auch die Forschung beruht und kann ohne spezielle Geräte gemessen werden)
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Tränen Osmolarität
Normalwert: ca. 280 - 306 Osmolarität (mOsms/L), Grenzwert/ cut-off: 306 mOsms/L
Mit dem Zahlenwert steigt die Osmolarität (Konzentration) der Salz und Proteine an. Die Interpretation der Tränenfilmosmolarität erfordert eine gewisse Einarbeitung in das Thema, denn nicht nur der absolute Wert ist aussagekräftig sondern auch z.B. Differenzen zwischen beiden Augen.
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Tränen-Menge / Tränenmeniskus Höhe (TMH)
Normalwert: ≥ 0,2 mm
(Höhe des Tränenvolumens auf der Augenoberfläche)
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Vitalfärbung
Normalwert: “0” - (d.h. eine normale Augenoberfläche sollte keine anfärbbaren Defekte haben)
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LId-Parallele COnjunctivale Falten (LIPCOF)
Normalwert: “0“ - ( d.h. eine normale Augenoberfläche sollte keine Bindehaut-Auflockerungen haben, die sich über der Lidkante auffalten)
Pathologische LIPCOF falten der Bindehaut werden eingeteilt entsprechend der Zahl und Grösse in typischerweise 3 Stufen (1-3)
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Konjunktivaler Rötungsindex
Normalwert: ≤ 1 (hängt ab von der Skalierung des verwendeten Gerätes)
(Zunehmende Rötung der Augenoberfläche wird typischerweise gewertet als ansteigender Wert von 0-3. Eine gewissen Rötung ist normal, da die Augenoberfläche einen gewissen normalen Blutfluss in den Gefässen benötigt)
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MMP-9 Enzym Test (Erkennung einer Entzündung)
Normalwert: “Negativ”
Ein positiver Test zeigt einen erhöhten Wert des Gewebe-abbauenden Enzyms MMP9 über einen Grenzwert, der noch als normal angesehen wird und zeigt daher eine Entzündung der Augenoberfläche an.
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Schirmer-1 Tränentest
Normalwert: ≥ 10 Millimeter in 5 Minuten
(zeigt die Menge neuer Tränenproduktion als die Länge der Befeuchtung eines Papierstreifens)
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Diagnostische Expression der Meibomdrüsen - Lipidausschüttung
Normalwert: Meibomdrüsen aktiver Drüsen mit flüssigem Sekret (MGYLS)
meist angegeben als: (Anzahl der aktiven Drüsen pro Lid) ca. 6-10 / 15 (untersuchte Drüsen)
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Meibographie
Normalwert: “0“
Darstellung der Menge der Meibomdrüsen im Lid: Klassifizierung von “0“ Normal (alle Drüsen vorhanden) über zunehmenden Verlust von jeweils einem Drittel in den Stufen 1-3 - Bei Stufe 3 = Verlust von 3/3 der Drüsen (also praktisch keine Drüsen mehr vorhanden)
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______ ENGLISCH
Lipid Layer Thickness
Normal value: ≥ 65 ICU units (roughly equivalent to 65nm) normal up to about 100 ICU
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Incomplete Blinks – Alterations of regular Eyelid Blinking
Normal value: ca. 20% of blinks are incomplete (References in Literature differ somewhat)
Pathologic: > 50% incomplete eyelid blinks
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Tear Film - Stability
Non-Invasive BUT (NI-BUT)
Normal value: ≥ 10 Sekunden
in NI-BUT the normal values are typically higher (than in F-BUT (see below), i.e. longer stability, because the tear film is not influenced by addition of a stain. Ni-BUT is simpler to measure, more comfortable and reveals numerical values … it is theoretically more exact
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Tear Film - Stability
with Fluorescein (F-BUT, Break-Up Time)
Normal value: ≥ 10 seconds
(F-BUT with fluorescein is the international standard on which the present research is based and can be measured without special equipment)
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Tear-Volume/ Tear Meniscus Height (TMH)
Normal value: ≥ 0,2 mm
(Height of the tear volume on the ocular surface)
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Tear Osmolarity
Normal values: ca. 280 - 306 Osmolarity (mOsms/L), Cut-off: 306 mOsms/L
With increasing numerical value also the tear osmolarity increases (concentration of the salts and proteins).
The interpretation of tear film osmolarity requires a certain background knowledge because not only the absolute value but also differences between both eyes are relevant.
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Vital staining
Normal value: “0” - (i.e. a normal ocular surface should have no vital staining micro-defects)
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LId-Parallel COnjunctival Folds (LIPCOF)
Normal value: “0“ - ( i.e. a normal ocular surface should not have loosened conjunctival tissue that build up folds on the lid margin)
Pathological LIPCOF folds of the conjunctiva are classified by increasing number and size in typically 3 grades (1-3)
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Conjunctival redness index
Normal value: ≤ 1 (depends on the actual grading scale of the equipment)
(Increeasing redness of the ocular surface is typically graded by increasing values from 0 to 3. A certain redness is normal since the ocular surface needs a certain normal blood flow)
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MMP-9 enzyme test (detection of inflammation)
Normal value: “Negative”
A positive test indicates a level of destructive enzyme (MMP9) above a threshold that is considered as normal and is regarded to indicate an inflammatory condition.
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Schirmer-1 Tear Test
Normal value: ≥ 10 millimeter in 5 minutes
(indicates the amount of new tear production as wetted area of a paper strip)
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Meibography
Normal value: “0“
Display of the Meibomian gland mass in the eyelids: Classification from “0“ Normal (all glands are present) along increasing loss of one thirds on the glands each in the grades 1-3. In grade 3 = loss of 3/3 of glands (i.e. practically no more glands present)
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Diagnostic expression of the meibomian glands - lipid delivery
Normal value: Meibomian glands yielding liquid secretion (MGYLS)
typically indicated as: (No of secreting glands) ca. 6-10 / 15 (investigated glands)
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_____
Diagnostic expression of the meibomian glands - lipid delivery
Normal value: Meibomian glands yielding liquid secretion (MGYLS)
typically indicated as: (No of secreting glands) ca. 6-10 / 15 (investigated glands)
The simplest test for the effective functionality, i.e. the ´activity´, of a meibomian glands is the technique of diagnostic gland expression. This is a test for the release of already produced oil from the duct system of the meibomian glands onto the eyelid margin.
Diagnostic expression of oil from the Meibomian glands is practically the 'oily equivalent' of Schirmer´s test for aqueous secretion of the lacrimal gland, because:
it tests the availability/ volume of a secretion product on the surface of the eye - in the case of the meibomian glands by testing the release of the oil on the edge of the eyelid.
it also tests the quality of the secretion, i.e. whether the lipids form a normal clear oil, are cloudy, contain granules or have a toothpaste-like condition.
The diagnostic expression of the meibomian oil is carried out by very mild pressure, for example with the finger on the outside of the eyelid margin (please see image) - such as through muscle contraction during normal blinking.
In order to maintain the very mild pressure (1.25g per mm2) that arises with normal blinking, a standardization was achieved by Donald Korb, Boston. He constructed a small hand-held instrument - the MGE, Meibomian Gland Evaluator (TearScience Inc, JnJ). This is a very useful little instrument for those who are really interested in dry eye disease and Meibomian gland dysfunction (MGD).
The MGE generates exactly the defined pressure onto an area under which about 5 meibomian glands are located. In this way, 5 meibomian glands are tested together in a standardized way in each lower eyelid to get an idea of the condition of the meibomian glands and their oil formation.
In order to standardize diagnostic expression even more, the expression must always be performed in the same 3 locations along the eyelid margin, i.e. in the nasal, medial or temporal part of the lower eyelid margin. This is important as it was observed by Blackie and Korb that the activity of the Meibomian glands have typically different activity in the different locations along the lid margin. Best is of course if all three locations are tested in every patient and the respective results compared.
Investigated glands: 5 glands each in 3 locations (nasal, medial, temporal) along the lid margin makes 15 glands that are evaluated. The evaluation reveals the “Meibomian gland score” that consists of different parameters as shown below:
Meibomian gland score
MGYLS (liquid secretion)
Typically only the number of meibomian glands yielding liquid secretion (MGYLS) is evaluated among the 15 glands along each eyelid as described above. This refers to glands that reveal any liquid secretion - either clear or cloudy. Toothpaste like secretum is therefore excluded.
Optimal Clear secretion
More focused is the recording of only those glands that yield an optimal clear liquid oil, which excludes already those glands that produce cloudy oil.
Total Meibomian gland score reveals more detailed information
= sum of the factors for all 15 investigated glands along each lid margin (result: 0 to 45)
Secretion Characteristics factor
clear liquid secretion (3)
cloudy liquid secretion (2)
inspissated/toothpaste-like (1)
no secretion (0)