Assessing the Structure of Tear Ferning in a Group of Healthy Young Subjects: A Pilot Study

Essam Saad Almutleb1 , * Open Modal Authors Info & Affiliations
The Open Ophthalmology Journal 10 Feb 2023 RESEARCH ARTICLE DOI: 10.2174/18743641-v17-e230116-2022-11



The purpose of the current pilot study is to investigate the structure of tear ferning in female and male subjects of different ages.


A total of six normal subjects participated in the current pilot cross-sectional study. The female subjects were 11, 28, and 42 years old, whereas the male subjects were 28, 32, and 34 years old. Five tear samples were collected from each subject using capillary tubes. A small drop (1 μl) of tears was dried on a glass slide and observed under a light microscope (Olympus BX1). Rolando (four grades) and Masmali (five grades) scales were used to classify the tear ferning patterns.


The tear film pattern of all the subjects was surrounded by three thick and homogenous peripheral layers. The layers surrounding the ferning were better distinguished in the 11-year-old female compared to the layers around the ferning in other subjects. The tear ferning of the 11-year-old female was very fine without any spacing and considered as a Grade 0 (Masmali), Type 1 (Roland), whereas the 28-year-old female had Grade 3 (Masmali), Type 4 (Rolando). The 28-year-old male had Grade 1 (Masmali), Type 2 (Rolando), whereas the 34-year-old male and 42-year-old male had ferning of Grade 3 (Masmali), Type 4 (Rolando).


The current pilot study showed that irrespective of gender, ferning patterning and grading degenerated and increased, respectively, as the age of the participants increased. Furthermore, the grading of ferning was better in male participants compared to female participants.

Keywords: Tear ferning pattern, Tear film, Age, Ocular surface, Gender, Ferning.
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