Qualitative analysis and clinical implications of lipid layer thickness variability: A retrospective, cross-sectional study

Jiyoung Emily Lee, Dong-Kyu Kim, Hye Yeon Yoon, Woong-Joo Whang, Ho Sik Hwang, Hyun-Seung Kim, Reiko Arita, Eun Chul Kim and Kyung-Sun Na

PLOS ONE, 2026, vol. 21, issue 9, 1-11

Abstract: Meibomian gland (MG) dysfunction impairs the tear film lipid layer, which is critical for preventing aqueous evaporation and maintaining tear film stability. While a LipiView® II-reported mean lipid layer thickness (LLT) of ≥100 nm indicates a high- or ceiling-range device output rather than a calibrated absolute LLT, mean LLT alone may overlook clinically relevant information about the dynamic behavior of the tear film. This study aimed to evaluate whether qualitative variability in 20-s LipiView® II dynamic LLT traces is associated with MG morphology and ocular surface findings in eyes with device-reported high-range LLT values. In this retrospective, cross-sectional study, we analyzed 20-s dynamic LipiView® II recordings from eyes that were initially measured to have a mean LLT of ≥100 nm. Two masked observers classified LLT pattern variability as high or low based on predefined criteria. Clinical and demographic differences between the high- and low-variability groups were assessed statistically. Out of 85 eyes, 58 (68.2%) and 27 (31.8%) exhibited high- and low-variability, respectively. The high-variability group demonstrated markedly elevated meiboscores compared to the low-variability group, indicating a greater degree of MG dropouts (p = 0.042). Besides elevated meiboscores, patients in the high-variability group suffered from substantially worse dry eye disease (DED) symptoms, a trend toward higher corneal and conjunctival staining scores, and significantly increased blinking frequency (p

Date: 2026
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0357020

DOI: 10.1371/journal.pone.0357020

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